hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|FL,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Doctors' Memorial Hospital,2/28/2025,2.0.0,Doctors' Memorial Hospital,"333 N Byron Butler Pkwy,Perry, FL 32347",593122517,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|AETNA|COMMERCIAL|negotiated_dollar,standard_charge|AETNA|COMMERCIAL|negotiated_percentage,standard_charge|AETNA|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA|COMMERCIAL,standard_charge|AETNA|COMMERCIAL|methodology,additional_payer_notes|AETNA|COMMERCIAL,standard_charge|AETNA MEDICARE|MEDICARE|negotiated_dollar,standard_charge|AETNA MEDICARE|MEDICARE|negotiated_percentage,standard_charge|AETNA MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|AETNA MEDICARE|MEDICARE,standard_charge|AETNA MEDICARE|MEDICARE|methodology,additional_payer_notes|AETNA MEDICARE|MEDICARE,standard_charge|BCBS MEDICARE|MEDICARE|negotiated_dollar,standard_charge|BCBS MEDICARE|MEDICARE|negotiated_percentage,standard_charge|BCBS MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|BCBS MEDICARE|MEDICARE,standard_charge|BCBS MEDICARE|MEDICARE|methodology,additional_payer_notes|BCBS MEDICARE|MEDICARE,standard_charge|BCBS NETWORK BLUE|COMMERCIAL|negotiated_dollar,standard_charge|BCBS NETWORK BLUE|COMMERCIAL|negotiated_percentage,standard_charge|BCBS NETWORK BLUE|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS NETWORK BLUE|COMMERCIAL,standard_charge|BCBS NETWORK BLUE|COMMERCIAL|methodology,additional_payer_notes|BCBS NETWORK BLUE|COMMERCIAL,standard_charge|BCBS PHS|COMMERCIAL|negotiated_dollar,standard_charge|BCBS PHS|COMMERCIAL|negotiated_percentage,standard_charge|BCBS PHS|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS PHS|COMMERCIAL,standard_charge|BCBS PHS|COMMERCIAL|methodology,additional_payer_notes|BCBS PHS|COMMERCIAL,standard_charge|BCBS PPO|COMMERCIAL|negotiated_dollar,standard_charge|BCBS PPO|COMMERCIAL|negotiated_percentage,standard_charge|BCBS PPO|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS PPO|COMMERCIAL,standard_charge|BCBS PPO|COMMERCIAL|methodology,additional_payer_notes|BCBS PPO|COMMERCIAL,standard_charge|BIG BEND HOSPICE|COMMERCIAL|negotiated_dollar,standard_charge|BIG BEND HOSPICE|COMMERCIAL|negotiated_percentage,standard_charge|BIG BEND HOSPICE|COMMERCIAL|negotiated_algorithm,estimated_amount|BIG BEND HOSPICE|COMMERCIAL,standard_charge|BIG BEND HOSPICE|COMMERCIAL|methodology,additional_payer_notes|BIG BEND HOSPICE|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|methodology,additional_payer_notes|CIGNA|COMMERCIAL,standard_charge|COVENANT HOSPICE|COMMERCIAL|negotiated_dollar,standard_charge|COVENANT HOSPICE|COMMERCIAL|negotiated_percentage,standard_charge|COVENANT HOSPICE|COMMERCIAL|negotiated_algorithm,estimated_amount|COVENANT HOSPICE|COMMERCIAL,standard_charge|COVENANT HOSPICE|COMMERCIAL|methodology,additional_payer_notes|COVENANT HOSPICE|COMMERCIAL,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|negotiated_dollar,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|negotiated_percentage,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL|COMMERCIAL,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|methodology,additional_payer_notes|HUMANA COMMERCIAL|COMMERCIAL,standard_charge|HUMANA MEDICAID|MEDICAID|negotiated_dollar,standard_charge|HUMANA MEDICAID|MEDICAID|negotiated_percentage,standard_charge|HUMANA MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|HUMANA MEDICAID|MEDICAID,standard_charge|HUMANA MEDICAID|MEDICAID|methodology,additional_payer_notes|HUMANA MEDICAID|MEDICAID,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_dollar,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_percentage,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA MEDICARE|MEDICARE,standard_charge|HUMANA MEDICARE|MEDICARE|methodology,additional_payer_notes|HUMANA MEDICARE|MEDICARE,standard_charge|MAGELLAN|MEDICAID|negotiated_dollar,standard_charge|MAGELLAN|MEDICAID|negotiated_percentage,standard_charge|MAGELLAN|MEDICAID|negotiated_algorithm,estimated_amount|MAGELLAN|MEDICAID,standard_charge|MAGELLAN|MEDICAID|methodology,additional_payer_notes|MAGELLAN|MEDICAID,standard_charge|MEDICAID|MEDICAID|negotiated_dollar,standard_charge|MEDICAID|MEDICAID|negotiated_percentage,standard_charge|MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|MEDICAID|MEDICAID,standard_charge|MEDICAID|MEDICAID|methodology,additional_payer_notes|MEDICAID|MEDICAID,standard_charge|MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MEDICARE|MEDICARE,standard_charge|MEDICARE|MEDICARE|methodology,additional_payer_notes|MEDICARE|MEDICARE,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_dollar,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_percentage,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_algorithm,estimated_amount|MULTIPLAN|COMMERCIAL,standard_charge|MULTIPLAN|COMMERCIAL|methodology,additional_payer_notes|MULTIPLAN|COMMERCIAL,standard_charge|SIMPLY HEALTHCARE|MEDICAID|negotiated_dollar,standard_charge|SIMPLY HEALTHCARE|MEDICAID|negotiated_percentage,standard_charge|SIMPLY HEALTHCARE|MEDICAID|negotiated_algorithm,estimated_amount|SIMPLY HEALTHCARE|MEDICAID,standard_charge|SIMPLY HEALTHCARE|MEDICAID|methodology,additional_payer_notes|SIMPLY HEALTHCARE|MEDICAID,standard_charge|STAYWELL FLORIDA HEALTHY KIDS|MEDICAID|negotiated_dollar,standard_charge|STAYWELL FLORIDA HEALTHY KIDS|MEDICAID|negotiated_percentage,standard_charge|STAYWELL FLORIDA HEALTHY KIDS|MEDICAID|negotiated_algorithm,estimated_amount|STAYWELL FLORIDA HEALTHY KIDS|MEDICAID,standard_charge|STAYWELL FLORIDA HEALTHY KIDS|MEDICAID|methodology,additional_payer_notes|STAYWELL FLORIDA HEALTHY KIDS|MEDICAID,standard_charge|STAYWELL MEDICAID|MEDICAID|negotiated_dollar,standard_charge|STAYWELL MEDICAID|MEDICAID|negotiated_percentage,standard_charge|STAYWELL MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|STAYWELL MEDICAID|MEDICAID,standard_charge|STAYWELL MEDICAID|MEDICAID|methodology,additional_payer_notes|STAYWELL MEDICAID|MEDICAID,standard_charge|STAYWELL MEDICARE|MEDICARE|negotiated_dollar,standard_charge|STAYWELL MEDICARE|MEDICARE|negotiated_percentage,standard_charge|STAYWELL MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|STAYWELL MEDICARE|MEDICARE,standard_charge|STAYWELL MEDICARE|MEDICARE|methodology,additional_payer_notes|STAYWELL MEDICARE|MEDICARE,standard_charge|SUNSHINE|MEDICARE|negotiated_dollar,standard_charge|SUNSHINE|MEDICARE|negotiated_percentage,standard_charge|SUNSHINE|MEDICARE|negotiated_algorithm,estimated_amount|SUNSHINE|MEDICARE,standard_charge|SUNSHINE|MEDICARE|methodology,additional_payer_notes|SUNSHINE|MEDICARE,standard_charge|UHC|COMMERCIAL|negotiated_dollar,standard_charge|UHC|COMMERCIAL|negotiated_percentage,standard_charge|UHC|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC|COMMERCIAL,standard_charge|UHC|COMMERCIAL|methodology,additional_payer_notes|UHC|COMMERCIAL,standard_charge|UHC MEDICAID|MEDICAID|negotiated_dollar,standard_charge|UHC MEDICAID|MEDICAID|negotiated_percentage,standard_charge|UHC MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|UHC MEDICAID|MEDICAID,standard_charge|UHC MEDICAID|MEDICAID|methodology,additional_payer_notes|UHC MEDICAID|MEDICAID,standard_charge|UHC MEDICARE|MEDICARE|negotiated_dollar,standard_charge|UHC MEDICARE|MEDICARE|negotiated_percentage,standard_charge|UHC MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|UHC MEDICARE|MEDICARE,standard_charge|UHC MEDICARE|MEDICARE|methodology,additional_payer_notes|UHC MEDICARE|MEDICARE,standard_charge|UHC VA CCN|MEDICARE|negotiated_dollar,standard_charge|UHC VA CCN|MEDICARE|negotiated_percentage,standard_charge|UHC VA CCN|MEDICARE|negotiated_algorithm,estimated_amount|UHC VA CCN|MEDICARE,standard_charge|UHC VA CCN|MEDICARE|methodology,additional_payer_notes|UHC VA CCN|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
BROMETANE-DX SYRUP 5ML:5ML,1,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
RONDEC SYRUP 5ML:5ML,2,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
REMDESIVIR LOADING DOSE - 200 MG/210 ML,3730,CDM,250,RC,C9399,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,260,40,,208,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
REMDESIVIR MNTNCE DOSE - 100 MG/80 ML,3731,CDM,250,RC,C9399,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,260,40,,208,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
OCTREOTIDE INFUSION 1000 MCG/NS 250 ML,3732,CDM,250,RC,C9399,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,260,40,,208,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
MEROPENEM 500 MG/NS 50 ML,4190,CDM,636,RC,J2185,HCPCS,OUTPATIENT,,,7.12,2.85,,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.27,60,,3.42,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,6.05,85,,4.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,4.98,70,,3.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,6.05,
CEFEPIME 2 GM/NS 50 ML,4191,CDM,636,RC,J0692,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
VENOFER 100 MG/NS 100 ML,4197,CDM,636,RC,J1756,HCPCS,OUTPATIENT,,,0.78,0.31,,,,,,other ,not seperately reimbursable,0.25,32,,0.2,percent of total billed charges,32% of total billed charges,0.25,32,,0.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.47,60,,0.38,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.66,85,,0.53,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.78,70,,0.62,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.25,0.78,
VENOFER 200 MG/NS 100 ML,4198,CDM,636,RC,J1756,HCPCS,OUTPATIENT,,,0.78,0.31,,,,,,other ,not seperately reimbursable,0.25,32,,0.2,percent of total billed charges,32% of total billed charges,0.25,32,,0.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.47,60,,0.38,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.66,85,,0.53,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.78,70,,0.62,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.78,32,,0.62,percent of total billed charges,32% of total billed charges,0.25,0.78,
TRANEXAMIC ACID 1000 MG/NS 100 ML,4203,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
MAGIC MOUTHWASH THRUSH - 1:1:1 RATIO,4205,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PANTOPRAZOLE 80 MG/NS 100 ML - INFUSION,4226,CDM,250,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
DOXYCYCLINE 100 MG/NS 100 ML,4281,CDM,250,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
ORBACTIV 1.2 GM/D5W 1000 ML,4285,CDM,636,RC,J2407,HCPCS,OUTPATIENT,,,1263.00,505.20,,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,757.8,60,,606.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,884.1,70,,707.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,1073.55,
DAPTOmycin  500 MG/NS 50 ML,4371,CDM,636,RC,J0878,HCPCS,OUTPATIENT,,,51.14,20.46,,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.68,60,,24.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,43.47,85,,34.78,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,35.8,70,,28.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,43.47,
MEROPENEM 1 GM/NS 50 ML,4375,CDM,250,RC,J2185,HCPCS,OUTPATIENT,,,11.69,4.68,,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.01,60,,5.61,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,9.94,85,,7.95,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,8.18,70,,6.54,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,9.94,
STREPTOMYCIN 500 MG/NS 100 ML,4411,CDM,250,RC,J3000,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
CALCIUM CHLORIDE 1 GM/NS 100 ML,4487,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
DAPTOmycin  350 MG/NS 50 ML,4756,CDM,636,RC,J0878,HCPCS,OUTPATIENT,,,51.14,20.46,,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.68,60,,24.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,43.47,85,,34.78,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,35.8,70,,28.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,43.47,
MICAFUNGIN 100 MG/NS 100 ML,4826,CDM,636,RC,J2247,HCPCS,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
VASOPRESSIN 40 UNITS/NS 100 ML,4842,CDM,250,RC,,,OUTPATIENT,,,139.70,55.88,,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.82,60,,67.06,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,118.75,85,,95,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,97.79,70,,78.23,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,118.75,
LEVOPHED CONC. DRIP 16 MG/D5W 250 ML,4844,CDM,250,RC,,,OUTPATIENT,,,12.42,4.97,,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.45,60,,5.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,10.56,85,,8.45,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,8.69,70,,6.95,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,10.56,
VECURONIUM 50 MG/NS 50 ML,4846,CDM,251,RC,,,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
PHENYLEPHRINE 40 MG/NS 100 ML,4847,CDM,636,RC,J2371,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
RESOLUTION CLIP,610057,CDM,271,RC,,,OUTPATIENT,,,602.00,240.80,,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361.2,60,,288.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240.8,40,,192.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,511.7,85,,409.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,421.4,70,,337.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,511.7,
HARMONIC ACE 36CM HANDLE,610060,CDM,271,RC,,,OUTPATIENT,,,1316.00,526.40,,,,,,other ,not seperately reimbursable,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,789.6,60,,631.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,526.4,40,,421.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,1118.6,85,,894.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,921.2,70,,736.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,421.12,32,,336.9,percent of total billed charges,32% of total billed charges,421.12,1118.6,
NEEDLE EPIDERL 6IN,610065,CDM,271,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12,40,,9.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
NEEDLE EPIDERL 6IN,610066,CDM,271,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12,40,,9.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
DEBRIEDMENT OF SUBQ TISSUE 1ST 20,611042,CDM,360,RC,11042,HCPCS,OUTPATIENT,,,1138.00,455.20,,3000,100,,,case rate,pays based on per visit rate,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,682.8,60,,546.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,162.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,967.3,85,,773.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,796.6,70,,637.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,364.16,32,,291.33,percent of total billed charges,32% of total billed charges,162.43,3000,
DEBRIDEMENT MUSCLE AND FASCIA  1ST <20CM,611043,CDM,360,RC,11043,HCPCS,OUTPATIENT,,,1795.00,718.00,,3000,100,,,case rate,pays based on per visit rate,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1077,60,,861.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,297,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,1525.75,85,,1220.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,1256.5,70,,1005.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,574.4,32,,459.52,percent of total billed charges,32% of total billed charges,297,3000,
PARING OR CUTTING PROCEDURE ON SKIN,611055,CDM,360,RC,11055,HCPCS,OUTPATIENT,,,573.00,229.20,,3000,100,,,case rate,pays based on per visit rate,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,343.8,60,,275.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,487.05,85,,389.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,401.1,70,,320.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,89.51,3000,
EXCISION BENIGN LESION 2.1 - 3.0 CM,611423,CDM,360,RC,11423,HCPCS,OUTPATIENT,,,4633.00,1853.20,,3000,100,,,case rate,pays based on per visit rate,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2779.8,60,,2223.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,3938.05,85,,3150.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,3243.1,70,,2594.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,259,3938.05,
EXCISION MALIGNAT PROCEDURE ON SKIN,611602,CDM,360,RC,11602,HCPCS,OUTPATIENT,,,1140.00,456.00,,3000,100,,,case rate,pays based on per visit rate,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,684,60,,547.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,306.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,969,85,,775.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,798,70,,638.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,364.8,32,,291.84,percent of total billed charges,32% of total billed charges,306.24,3000,
EXCISION MAL+MARGIN >4.0 CM,611606,CDM,360,RC,11606,HCPCS,OUTPATIENT,,,4632.00,1852.80,,3000,100,,,case rate,pays based on per visit rate,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2779.2,60,,2223.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,570.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,3937.2,85,,3149.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,3242.4,70,,2593.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,1482.24,32,,1185.79,percent of total billed charges,32% of total billed charges,419,3937.2,
EXCISION MALIGNANT LESION ON SKIN,611643,CDM,360,RC,11643,HCPCS,OUTPATIENT,,,4633.00,1853.20,,3000,100,,,case rate,pays based on per visit rate,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2779.8,60,,2223.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,398.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,3938.05,85,,3150.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,3243.1,70,,2594.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,398.04,3938.05,
EXCISION MALIGNANT LESION,611644,CDM,360,RC,11644,HCPCS,OUTPATIENT,,,1853.00,741.20,,3000,100,,,case rate,pays based on per visit rate,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1111.8,60,,889.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,492.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,1575.05,85,,1260.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,1297.1,70,,1037.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,592.96,32,,474.37,percent of total billed charges,32% of total billed charges,419,3000,
INTERMEDIATE REPAIR OF WOUNDS,612037,CDM,360,RC,12037,HCPCS,OUTPATIENT,,,1566.00,626.40,,3000,100,,,case rate,pays based on per visit rate,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,939.6,60,,751.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,624.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,1331.1,85,,1064.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,1096.2,70,,876.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,419,3000,
REPAIR OF INTEGUMENTARY SYSTEM,613160,CDM,360,RC,13160,HCPCS,OUTPATIENT,,,5210.00,2084.00,,3000,100,,,case rate,pays based on per visit rate,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3126,60,,2500.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1033.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,4428.5,85,,3542.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,3647,70,,2917.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,419,4428.5,
SKIN GRAFT 20 CM OR LESS,615220,CDM,360,RC,15220,HCPCS,OUTPATIENT,,,5210.00,2084.00,,3000,100,,,case rate,pays based on per visit rate,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3126,60,,2500.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,967.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,4428.5,85,,3542.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,3647,70,,2917.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,1667.2,32,,1333.76,percent of total billed charges,32% of total billed charges,419,4428.5,
SKIN GRAFT EACH ADD 20 CM,615221,CDM,360,RC,15221,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
BREAST BIOPSY WOITH PLACEMENT OF DEVICE,619082,CDM,360,RC,19082,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
REMOVAL OF FB MUSCLE OR TENDON,620525,CDM,360,RC,20525,HCPCS,OUTPATIENT,,,8120.00,3248.00,,3000,100,,,case rate,pays based on per visit rate,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4872,60,,3897.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,592.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,6902,85,,5521.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,5684,70,,4547.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,2598.4,32,,2078.72,percent of total billed charges,32% of total billed charges,479,6902,
ASPIRARING OR INJECTING A GANGION CYST,620612,CDM,360,RC,20612,HCPCS,OUTPATIENT,,,847.00,338.80,,3000,100,,,case rate,pays based on per visit rate,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,508.2,60,,406.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,719.95,85,,575.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,592.9,70,,474.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,81.16,3000,
UNLISTED MUSCULOSKELETAL PROC,620999,CDM,360,RC,20999,HCPCS,OUTPATIENT,,,675.00,270.00,,3000,100,,,case rate,pays based on per visit rate,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405,60,,324,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,472.5,70,,378,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,3000,
REPAIR OF ROTATOR CUFF ACUTE,623410,CDM,360,RC,23410,HCPCS,OUTPATIENT,,,20448.00,8179.20,,3000,100,,,case rate,pays based on per visit rate,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,12268.8,60,,9815.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1069.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,17380.8,85,,13904.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,14313.6,70,,11450.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,674,17380.8,
REPAIR BICEPTS TENDON,623430,CDM,360,RC,23430,HCPCS,OUTPATIENT,,,20448.00,8179.20,,3000,100,,,case rate,pays based on per visit rate,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,12268.8,60,,9815.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,970.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,17380.8,85,,13904.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,14313.6,70,,11450.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,6543.36,32,,5234.69,percent of total billed charges,32% of total billed charges,591,17380.8,
ENDOSCOPY W/CONTROL OF BLEEDING,625315,CDM,750,RC,45315,HCPCS,OUTPATIENT,,,274.00,109.60,,3000,100,,,case rate,pays based on per visit rate,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,164.4,60,,131.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,297.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,191.8,70,,153.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,3000,
EXCISION OF TUMOR HAND FINGER 1.5M>,626111,CDM,360,RC,26111,HCPCS,OUTPATIENT,,,4633.00,1853.20,,3000,100,,,case rate,pays based on per visit rate,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2779.8,60,,2223.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,537.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,3938.05,85,,3150.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,3243.1,70,,2594.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,1482.56,32,,1186.05,percent of total billed charges,32% of total billed charges,537.83,3938.05,
AMPUTATION OF FINGER / THUMB,626952,CDM,360,RC,26952,HCPCS,OUTPATIENT,,,9000.00,3600.00,,3000,100,,,case rate,pays based on per visit rate,2880,32,,2304,percent of total billed charges,32% of total billed charges,2880,32,,2304,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,5400,60,,4320,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,884.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,7650,85,,6120,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,2880,32,,2304,percent of total billed charges,32% of total billed charges,6300,70,,5040,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,2880,32,,2304,percent of total billed charges,32% of total billed charges,591,7650,
DRAINAGE OF PELVIS LESION,626990,CDM,360,RC,26990,HCPCS,OUTPATIENT,,,9250.00,3700.00,,3000,100,,,case rate,pays based on per visit rate,2960,32,,2368,percent of total billed charges,32% of total billed charges,2960,32,,2368,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,5550,60,,4440,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,887.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,7862.5,85,,6290,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,2960,32,,2368,percent of total billed charges,32% of total billed charges,6475,70,,5180,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,2960,32,,2368,percent of total billed charges,32% of total billed charges,312,7862.5,
REMOVE FEMUR LESION BURSA,627062,CDM,360,RC,27062,HCPCS,OUTPATIENT,,,9252.00,3700.80,,3000,100,,,case rate,pays based on per visit rate,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,5551.2,60,,4440.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,592.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,7864.2,85,,6291.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,6476.4,70,,5181.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,592.06,7864.2,
TENDON REPAIR KNEECAP,627380,CDM,360,RC,27380,HCPCS,OUTPATIENT,,,20447.00,8178.80,,3000,100,,,case rate,pays based on per visit rate,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,12268.2,60,,9814.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,811,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,17379.95,85,,13903.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,14312.9,70,,11450.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,312,17379.95,
INCISION OF FOOT FACIA,628008,CDM,360,RC,28008,HCPCS,OUTPATIENT,,,9252.00,3700.80,,3000,100,,,case rate,pays based on per visit rate,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,5551.2,60,,4440.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,535.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,7864.2,85,,6291.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,6476.4,70,,5181.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,2960.64,32,,2368.51,percent of total billed charges,32% of total billed charges,479,7864.2,
PARTIAL REMOVAL OF FOOT FASCIA,628060,CDM,360,RC,28060,HCPCS,OUTPATIENT,,,9250.00,3700.00,,3000,100,,,case rate,pays based on per visit rate,2960,32,,2368,percent of total billed charges,32% of total billed charges,2960,32,,2368,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,5550,60,,4440,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,652.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,7862.5,85,,6290,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,2960,32,,2368,percent of total billed charges,32% of total billed charges,6475,70,,5180,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2960,32,,2368,percent of total billed charges,32% of total billed charges,2960,32,,2368,percent of total billed charges,32% of total billed charges,419,7862.5,
PARTIAL REMOVAL OF METATARSAL,628111,CDM,360,RC,28111,HCPCS,OUTPATIENT,,,9000.00,3600.00,,3000,100,,,case rate,pays based on per visit rate,2880,32,,2304,percent of total billed charges,32% of total billed charges,2880,32,,2304,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,5400,60,,4320,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,603.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,7650,85,,6120,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,2880,32,,2304,percent of total billed charges,32% of total billed charges,6300,70,,5040,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2880,32,,2304,percent of total billed charges,32% of total billed charges,2880,32,,2304,percent of total billed charges,32% of total billed charges,479,7650,
FUSION OF BIG TOE JOINT,628750,CDM,360,RC,28750,HCPCS,OUTPATIENT,,,20447.00,8178.80,,3000,100,,,case rate,pays based on per visit rate,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,12268.2,60,,9814.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,992.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,17379.95,85,,13903.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,14312.9,70,,11450.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,6543.04,32,,5234.43,percent of total billed charges,32% of total billed charges,591,17379.95,
EXCISION LYMPH NODES / CHANNELS,638542,CDM,360,RC,38542,HCPCS,OUTPATIENT,,,16490.00,6596.00,,3000,100,,,case rate,pays based on per visit rate,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9894,60,,7915.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,680.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,14016.5,85,,11213.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,11543,70,,9234.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,419,14016.5,
REMOVAL OF RECTAL OBSTRUCTION,645915,CDM,360,RC,45915,HCPCS,OUTPATIENT,,,3372.00,1348.80,,3000,100,,,case rate,pays based on per visit rate,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2023.2,60,,1618.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,454.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,2866.2,85,,2292.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,2360.4,70,,1888.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,1079.04,32,,863.23,percent of total billed charges,32% of total billed charges,312,3000,
REMOVAL  OF HEMMORHOIDS,646260,CDM,360,RC,46260,HCPCS,OUTPATIENT,,,8025.00,3210.00,,3000,100,,,case rate,pays based on per visit rate,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4815,60,,3852,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,632.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,6821.25,85,,5457,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,5617.5,70,,4494,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,2568,32,,2054.4,percent of total billed charges,32% of total billed charges,479,6821.25,
CYSTOSCOPY,652265,CDM,360,RC,52265,HCPCS,OUTPATIENT,,,5820.00,2328.00,,3000,100,,,case rate,pays based on per visit rate,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3492,60,,2793.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,478.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,4947,85,,3957.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,4074,70,,3259.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,1862.4,32,,1489.92,percent of total billed charges,32% of total billed charges,478.78,4947,
COLPOSCOPY OF CERVIX WITH BIOPSY,657454,CDM,360,RC,57454,HCPCS,OUTPATIENT,,,918.00,367.20,,3000,100,,,case rate,pays based on per visit rate,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.8,60,,440.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,220.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,780.3,85,,624.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,642.6,70,,514.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,220.45,3000,
LAPROSCOPIC LYSIS OF ADHESIONS,658660,CDM,360,RC,58660,HCPCS,OUTPATIENT,,,16790.00,6716.00,,3000,100,,,case rate,pays based on per visit rate,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,10074,60,,8059.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,901.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,14271.5,85,,11417.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,11753,70,,9402.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,5372.8,32,,4298.24,percent of total billed charges,32% of total billed charges,674,14271.5,
LAPROSCOPIC TUBAL CATERY,658670,CDM,360,RC,58670,HCPCS,OUTPATIENT,,,16490.00,6596.00,,3000,100,,,case rate,pays based on per visit rate,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9894,60,,7915.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,486.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,14016.5,85,,11213.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,11543,70,,9234.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,5276.8,32,,4221.44,percent of total billed charges,32% of total billed charges,479,14016.5,
DEBRIDEMENT OPEN WOUND 1ST 20CM,697597,CDM,360,RC,97597,HCPCS,OUTPATIENT,,,573.00,229.20,,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,343.8,60,,275.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,487.05,85,,389.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,401.1,70,,320.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,183.36,32,,146.69,percent of total billed charges,32% of total billed charges,126.6,487.05,
TCC-EZ 3  BOOT SYSTEM,710000,CDM,271,RC,,,OUTPATIENT,,,3028.00,1211.20,,,,,,other ,not seperately reimbursable,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1816.8,60,,1453.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,2573.8,85,,2059.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,2119.6,70,,1695.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,968.96,32,,775.17,percent of total billed charges,32% of total billed charges,968.96,2573.8,
GLOVE SURG ORTHO SIZE 7,710010,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TCC-EZ REG BOOT,710020,CDM,271,RC,,,OUTPATIENT,,,190.00,76.00,,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114,60,,91.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,133,70,,106.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,161.5,
TCC-EZ LRG BOOT,710021,CDM,271,RC,,,OUTPATIENT,,,226.00,90.40,,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.6,60,,108.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,192.1,
SAME AS #15000043,711367,CDM,272,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
SAME #15000042,711370,CDM,272,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
SAME AS #15000031,711371,CDM,272,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
CATH FOLEY 14FR 5CC,711541,CDM,271,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PEAK FLOW METER REUSE,711632,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
TAPE MEDIPORE 2,711921,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MASK OXYGEN,712410,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
L&D OBVS SIMPLE-PER HR,800138,CDM,720,RC,99218,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,101.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,101.25,
L&D OBVS COMPLEX-PER HR,800139,CDM,720,RC,99220,HCPCS,OUTPATIENT,,,191.00,76.40,,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.6,60,,91.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,224.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,224.75,
***LD OBVS FIRST HOUR DO NOT USE,800140,CDM,720,RC,99219,HCPCS,OUTPATIENT,,,268.00,107.20,,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,60,,128.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,166.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,227.8,
LD OBVS EA ADD'L HR,800141,CDM,720,RC,99235,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,23.75,
"I&D ABSCESS (C,SH,C,CSQ,F,P) SMPL/SINGL",910060,CDM,361,RC,10060,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
I&D ABSCESS COMPLICATED/MULTIPLE,910061,CDM,361,RC,10060,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
I&D PILONIDAL CYST SIMPLE,910080,CDM,361,RC,10080,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
I&D PILONIDAL CYST COMPLICATED,910081,CDM,361,RC,10081,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
INS/REM FB SUBQ TISSUE SMPL,910120,CDM,361,RC,10120,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
INS/REM FB SUBQ TISSUE COMPLEX,910121,CDM,361,RC,10121,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
"I&D HEMATOMA, SEROMA OR FLUID COLLECTION",910140,CDM,361,RC,10140,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
"PUNCTURE ASP ABSCESS, HEMATOMA,BULLA, CY",910160,CDM,361,RC,10160,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
I&D COMPLEX POSTOP WND INFECTION,910180,CDM,361,RC,10180,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
DEBRIDE SUBQ 1ST 20 SQCM,911042,CDM,361,RC,11042,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
DEBRIDE MUSCLE/FASCIA -FIRST 20 SQCM OR<,911043,CDM,361,RC,11043,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
DEBRIDE BONE 1ST 20 SQCM OR <,911044,CDM,361,RC,11044,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
DEBRIDE SUB Q EA ADDNL 20 SQCM OR PART,911045,CDM,361,RC,11045,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
DEBRIDE MUSCLE/FASCIA - ADDNL 20 SQCM OR,911046,CDM,361,RC,11046,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
"DEBRIDE BONE, EA ADDNL 20 SQCM OR PART",911047,CDM,361,RC,11047,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
"PARING  HYPERKERATOTIC LESION, 1 LSN",911055,CDM,361,RC,11055,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
"PARING  HYPERKERATOTIC LESION, 2-4 LSN",911056,CDM,361,RC,11056,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
"PARING  HYPERKERATOTIC LESION, >4 LSN",911057,CDM,361,RC,11057,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
TANGENTIAL BX SKIN SNGL LESION,911102,CDM,361,RC,11102,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
TANGENTIAL BX SKIN EA ADDNL/SEP LESION,911103,CDM,361,RC,11103,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
PUNCH BX SKIN SNGL LESION,911104,CDM,361,RC,11104,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
PUNCH BX SKIN EA ADDNL/SEP LESION,911105,CDM,361,RC,11105,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
INCISIONAL BX SNGL LESION,911106,CDM,361,RC,11106,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
INCISIONAL BX EA ADDNL/SEP LESION,911107,CDM,361,RC,11107,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
TRIM NONDYSTROPHIC NAILS ANY NUMBER,911719,CDM,361,RC,11719,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
DEBRIDE NAILS ANY METH 1-5 NAILS,911720,CDM,361,RC,11720,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
DEBRIDE NAILS ANY METH 6 NAILS OR >,911721,CDM,361,RC,11721,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
AVULSION NAIL PLATE SMPL 1 PLATE,911730,CDM,361,RC,11730,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
AVULSION NAIL PLATE EA ADDNL PLATE,911732,CDM,361,RC,11732,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
EXC NAIL/NAIL MATRIX PERMANENT REMOVAL,911750,CDM,361,RC,11750,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
EPIDERM AUTOGRAFT TAL 1ST 100 SQCM OR<,915110,CDM,361,RC,15110,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
EPIDERM AUTOGRAFT TAL EA ADDNL 100 SQCM,915111,CDM,361,RC,15111,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,3000,
EPIDERM AUTOGRAFT FSEMNEOGHF/DIGITS 1ST,915115,CDM,361,RC,15115,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
EPIDERM AUTOGRAFT FSEMNEOGHF/DIGITS EA A,915116,CDM,361,RC,15116,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,3000,
"APP SKIN SUB GRAFT TAL WND 100SQCM, 1ST",915271,CDM,361,RC,15271,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
"APP SKIN SUB GRAFT TAL WND 100SQCM, EA A",915272,CDM,361,RC,15272,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
"APP SS GRAFT TAL WND 100SQCM, 1ST CH/INF",915273,CDM,361,RC,15273,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
"APP SS GRAFT TAL WND 100SQCM, EA CH/INF",915274,CDM,361,RC,15273,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
"APP SS GRAFT FSEMNEOGHF WND 100SQCM, 1ST",915275,CDM,361,RC,15275,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
"APP SS GRAFT FSEMNEOGHF WND 100SQCM, EA",915276,CDM,361,RC,15276,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
APP SS GRFT FSEMNEOGHF WND 1ST 100 SQCM,915277,CDM,361,RC,15277,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
APP SS GRAFT FSEMNEOGHF WND  EA ADDL 100,915278,CDM,361,RC,15278,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
DRESS/DEBRIDE PART THK BURN INT/SUB SMAL,916020,CDM,361,RC,16020,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
DRESS/DEBRIDE PART THK BURN INT/SUB MED,916025,CDM,361,RC,16025,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419,3000,
DRESS/DEBRIDE PART THK BURN INT/SUB LARG,916030,CDM,361,RC,16030,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,3000,
APPL  RIDGID TOTAL CONTACT LEG CAST,916031,CDM,361,RC,29445,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
CHEMICAL CAUTERY GRANULATED TISSUE,917250,CDM,361,RC,17250,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
..TEST LDL DIRECT CHOLESTEROL,919191,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST CATECHOLAMINES URINE,919192,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST CULTURE THROAT,919193,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST ANCA,919194,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST HEP PANEL W RFLX TO HCV,919195,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
"..TEST VIT D 1,25",919196,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST ALDOSTERONE,919197,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST HSV W RFX TO TYPING,919198,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST PTH AND CALCIUM,919199,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST CATECHOLAMINES S,919291,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST IMMUNOGLOBIN A,919292,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST CULTURE AEROBIC,919293,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
..TEST PEP,919294,CDM,301,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
APPLICATION TOTAL CONTACT LEG CAST,929445,CDM,361,RC,29445,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
APPLICATION UNNA BOOT,929580,CDM,361,RC,29580,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
APPLY MULTILAYER WND COMP BELOW KNEE,929581,CDM,361,RC,29581,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
REMOVE IMPACTED CERUMEN LAV/IGG UNI,969209,CDM,361,RC,69209,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
REMOVE IMPACTED CERUMEN INSTRUMENT UNI,969210,CDM,361,RC,69210,HCPCS,OUTPATIENT,,,,,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,3000,
"ED EXCISED ,BENIGN LESION DIA 0.6 /1.0cm",1112031,CDM,450,RC,11401,HCPCS,OUTPATIENT,,,698.00,279.20,,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.8,60,,335.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,196.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,488.6,70,,390.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,196.71,593.3,
WOUND CLOSURE UTALIZING TISS ADH(ONLY),1112045,CDM,450,RC,G0168,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,92.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,92.5,
ED DISLOCAT/FRACTURE W/ MANIPULATION,1121480,CDM,450,RC,23540,HCPCS,OUTPATIENT,,,1038.00,415.20,,,,,,other ,not seperately reimbursable,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,622.8,60,,498.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,308.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,882.3,85,,705.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,726.6,70,,581.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,332.16,32,,265.73,percent of total billed charges,32% of total billed charges,308.35,882.3,
ED CL FRAC W MAN CL DISTAL PHAL,1126750,CDM,450,RC,26750,HCPCS,OUTPATIENT,,,677.00,270.80,,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406.2,60,,324.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,473.9,70,,379.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,575.45,
OBVS SIMPLE-PER HR,1300138,CDM,762,RC,99218,HCPCS,OUTPATIENT,,,23.00,9.20,,1500,100,,,case rate,pays based on per visit rate,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,1500,
OBVS COMPLEX-PER HR,1300139,CDM,762,RC,99236,HCPCS,OUTPATIENT,,,38.00,15.20,,1500,100,,,case rate,pays based on per visit rate,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,1500,
OBVS FIRST HOUR,1300140,CDM,762,RC,99235,HCPCS,OUTPATIENT,,,287.00,114.80,,1500,100,,,case rate,pays based on per visit rate,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.2,60,,137.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,207.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,200.9,70,,160.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,1500,
OBVS EACH HOUR,1300141,CDM,762,RC,99219,HCPCS,OUTPATIENT,,,19.00,7.60,,1500,100,,,case rate,pays based on per visit rate,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,1500,
OBVS MEDICARE ADMIT ER,1300142,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,180.00,72.00,,1500,100,,,case rate,pays based on per visit rate,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108,60,,86.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,126,70,,100.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,1500,
OBSERVATION DIRECT ADMIT,1300143,CDM,762,RC,G0379,HCPCS,OUTPATIENT,,,1169.00,467.60,,1500,100,,,case rate,pays based on per visit rate,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,701.4,60,,561.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,993.65,85,,794.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,818.3,70,,654.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,374.08,32,,299.26,percent of total billed charges,32% of total billed charges,374.08,1500,
OBVS MED ER ADD'L HRS,1300144,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,47.00,18.80,,1500,100,,,case rate,pays based on per visit rate,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,1500,
OBSERVATIONS SERVICE PER HOUR,1300145,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,,,,1500,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1500,1500,
VACCINE ADMIN,1300146,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,20.56,113.9,
VACCINE ADMIN-INFLUENZA,1300147,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,20.56,72.25,
VACCINE ADMIN-PNEUNOCOCCAL,1300148,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,20.56,72.25,
ADM COVID VACCINE (PFIZER) 1ST DOSE,1300149,CDM,771,RC,0001A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (PFIZER) 2ND DOSE,1300150,CDM,771,RC,0002A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (MODERNA) 1ST DOSE,1300151,CDM,771,RC,0011A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (MODERNA) 2ND DOSE,1300152,CDM,771,RC,0012A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (ASTRA ZEN) 1ST DOSE,1300153,CDM,771,RC,0021A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (ASTRA ZEN) 2ND DOSE,1300154,CDM,771,RC,0022A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (J&J) SINGLE DOSE,1300155,CDM,771,RC,0031A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
CARDIOPULMONARY RESUSCITATION,1300156,CDM,489,RC,92950,HCPCS,OUTPATIENT,,,641.00,256.40,,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.6,60,,307.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,544.85,
OBVS SAME DAY ADMIT/DISCH FIRST HR,1300235,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,287.00,114.80,,1500,100,,,case rate,pays based on per visit rate,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.2,60,,137.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,200.9,70,,160.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,1500,
OBVS SAME DAY ADMIT/DISCH EA ADD'L HR,1300236,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,47.00,18.80,,1500,100,,,case rate,pays based on per visit rate,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,1500,
PICC LINE MS INSERT W/O IMAGING,1336569,CDM,761,RC,36569,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,121.45,2895.95,
PICC LINE MS INSERT W/ IMAGING,1336573,CDM,761,RC,36573,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,490.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,490.51,2895.95,
REP CVA MS CATH W/O P/P W/C/P INSERT SIT,1336575,CDM,761,RC,36575,HCPCS,OUTPATIENT,,,1312.00,524.80,,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,787.2,60,,629.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,188.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,1115.2,85,,892.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,918.4,70,,734.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,188.3,1115.2,
PICC REPL MS COMP W/O IMG SME VEIN ACCES,1336580,CDM,761,RC,36580,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,243.5,2895.95,
PICC REPL MS COMP  W/IMG SV ACCES,1336584,CDM,761,RC,36584,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,2895.95,
IV/SUBQ INF CASIR/IMDEV W/POST ADMIN MON,1336585,CDM,761,RC,M0243,HCPCS,OUTPATIENT,,,1091.00,436.40,,,,,,other ,not seperately reimbursable,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,654.6,60,,523.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,927.35,85,,741.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,763.7,70,,610.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,349.12,32,,279.3,percent of total billed charges,32% of total billed charges,349.12,927.35,
WOUND VAC UNIT,1500005,CDM,272,RC,E2402,HCPCS,OUTPATIENT,,,170.00,68.00,,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102,60,,81.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,119,70,,95.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,144.5,
CANISTER SET FOR WOUND VAC,1500006,CDM,272,RC,A7000,HCPCS,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,62.05,
DRESSING LARGE FOR WOUND VAC,1500007,CDM,272,RC,A6550,HCPCS,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
Y CONNECTOR,1500009,CDM,272,RC,A6550,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,36.16,
DRESSING FOAM ADHESIVE,1500012,CDM,272,RC,A6550,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,36.16,
CATH KIT 6FR,1500014,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
BARRIER SKIN 45MM,1500019,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
"EXCISION THROMBOSED HEMORRHOID, EXTERNAL",1502542,CDM,360,RC,46320,HCPCS,OUTPATIENT,,,2624.00,1049.60,,3000,100,,,case rate,pays based on per visit rate,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1574.4,60,,1259.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,272.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,2230.4,85,,1784.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,272.73,3000,
"CHROMIUM, SERUM",1715248,CDM,301,RC,82495,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,78.31,272,,,fee schedule,272% of BCBS fee schedule,78.31,272,,,fee schedule,272% of BCBS fee schedule,78.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,78.31,
PROCOLLAGEN TYPE I INTACT N TERMINAL PRO,1716609,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,23,119,
"INSULIN ABS (GAD65,IA-2)",1725192,CDM,302,RC,86337,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,82.66,272,,,fee schedule,272% of BCBS fee schedule,82.66,272,,,fee schedule,272% of BCBS fee schedule,82.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,26.76,93.5,
T4 TOTAL (THYROXINE),1763290,CDM,301,RC,84436,HCPCS,OUTPATIENT,,,222.00,88.80,,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,26.55,272,,,fee schedule,272% of BCBS fee schedule,26.55,272,,,fee schedule,272% of BCBS fee schedule,26.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,133.2,60,,106.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,155.4,70,,124.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,8.58,188.7,
PROCALCITONIN,1784145,CDM,301,RC,84145,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
XOPENEX 1.25 MG/3 ML NEBULIZER SOLN,1800206,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
VENT CIRCUIT PORTABLE,1800503,CDM,362,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SPINE THORACOLUMBAR 2 V,2207280,CDM,320,RC,72080,HCPCS,OUTPATIENT,,,133.00,53.20,,27.95,80,,,fee schedule,80% of Aetna fee schedule,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.8,60,,63.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,27.95,113.05,
SPINE SCOLIOSIS SUPINE & ERECT,2207290,CDM,320,RC,72090,HCPCS,OUTPATIENT,,,182.00,72.80,,38.66,80,,,fee schedule,80% of Aetna fee schedule,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,38.66,154.7,
CT T SP W/WO CONTRAST,2507130,CDM,352,RC,72130,HCPCS,OUTPATIENT,,,1644.00,657.60,,833.14,100,,,case rate,pays based on per visit rate,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,986.4,60,,789.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,1397.4,85,,1117.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,526.08,32,,420.86,percent of total billed charges,32% of total billed charges,179.55,1397.4,
TC-99M PYROPHOSPHATE DX STUDY DOSE UP TO,2509538,CDM,343,RC,A9538,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
NM CARDIAC AMYLOID SCAN,2578803,CDM,341,RC,78803,HCPCS,OUTPATIENT,,,4060.00,1624.00,,245.61,80,,,fee schedule,80% of Aetna fee schedule,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,594.02,272,,,fee schedule,272% of BCBS fee schedule,594.02,272,,,fee schedule,272% of BCBS fee schedule,594.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,2436,60,,1948.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,382.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,3451,85,,2760.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,2842,70,,2273.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,1299.2,32,,1039.36,percent of total billed charges,32% of total billed charges,245.61,3451,
MRI HEEL W/O CONTRAST,2607589,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1050.00,420.00,,750,100,,,case rate,pays based on per visit rate,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,630,60,,504,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,892.5,85,,714,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,735,70,,588,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,209.61,1015.54,
DEXTROSE 50% 50ML SDV,3100598,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
CLARITIN REDITABS: 10 MG,3101001,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
NS 100ML  ADD-VANTAGE :100ML,3226650,CDM,258,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
THERAPEUTIC ACTIVITIES PER 15 MIN,3597530,CDM,420,RC,97530,HCPCS,OUTPATIENT,,,85.00,34.00,GO,26.13,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,26.13,72.25,
PT RE EVAL,3600203,CDM,420,RC,97164,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
PHY THERAPIST SVCS IN HH SETTING 15 MIN,3600204,CDM,420,RC,G0159,HCPCS,OUTPATIENT,,,148.00,59.20,,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,60,,71.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,103.6,70,,82.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,125.8,
KNOT PUSHER,6000103,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,867.00,346.80,,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520.2,60,,416.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,736.95,
CANNULA 7X7,6000106,CDM,272,RC,,,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
ABLATOR,6000107,CDM,272,RC,,,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
PUMP TUBING,6000108,CDM,272,RC,,,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,126.65,
CATH COUNCIL 18FR,6000111,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
CATH COUNCIL 16FR,6000112,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
CIRCULAR STAPLER,6000113,CDM,272,RC,,,OUTPATIENT,,,1016.00,406.40,,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,609.6,60,,487.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,711.2,70,,568.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,325.12,863.6,
TUBE SET,6000114,CDM,272,RC,,,OUTPATIENT,,,270.00,108.00,,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162,60,,129.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,108,40,,86.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,189,70,,151.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,229.5,
OSTEOSET RESORBABLE BEAD,6000117,CDM,272,RC,,,OUTPATIENT,,,1636.00,654.40,,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,981.6,60,,785.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,654.4,40,,523.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,1390.6,85,,1112.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,1145.2,70,,916.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,1390.6,
RETRIEVAL SYSTEM 10MM,6000118,CDM,272,RC,C1773,HCPCS,OUTPATIENT,,,207.00,82.80,,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.2,60,,99.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.8,40,,66.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,144.9,70,,115.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,175.95,
ENDOPATH ECS29,6000122,CDM,272,RC,,,OUTPATIENT,,,1000.00,400.00,,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,60,,480,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,400,40,,320,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,850,85,,680,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,700,70,,560,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,320,850,
DRILL,6000127,CDM,272,RC,,,OUTPATIENT,,,1741.00,696.40,,,,,,other ,not seperately reimbursable,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1044.6,60,,835.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,696.4,40,,557.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,1479.85,85,,1183.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,1218.7,70,,974.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,557.12,32,,445.7,percent of total billed charges,32% of total billed charges,557.12,1479.85,
CRE #5845,6000129,CDM,272,RC,C1726,HCPCS,OUTPATIENT,,,729.00,291.60,,,,,,other ,not seperately reimbursable,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437.4,60,,349.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,291.6,40,,233.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,619.65,85,,495.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,510.3,70,,408.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,233.28,32,,186.62,percent of total billed charges,32% of total billed charges,233.28,619.65,
PORTA CATH TRIUMPH 1 8FR,6000133,CDM,278,RC,C1788,HCPCS,OUTPATIENT,,,1760.00,704.00,,,,,,other ,not seperately reimbursable,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1056,60,,844.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,704,40,,563.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,1496,85,,1196.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,1232,70,,985.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,563.2,32,,450.56,percent of total billed charges,32% of total billed charges,563.2,1496,
SUTURE J496G,6000136,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SUTURE Z259H,6000139,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SUTURE D9080,6000143,CDM,272,RC,,,OUTPATIENT,,,248.00,99.20,,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,60,,119.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,99.2,40,,79.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,210.8,85,,168.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,173.6,70,,138.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,210.8,
YAG LASER,6000144,CDM,272,RC,,,OUTPATIENT,,,600.00,240.00,,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,60,,288,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240,40,,192,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,420,70,,336,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,510,
MESH PHSE6,6000145,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1532.00,612.80,,,,,,other ,not seperately reimbursable,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,919.2,60,,735.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,612.8,40,,490.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,1302.2,85,,1041.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,1072.4,70,,857.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,490.24,32,,392.19,percent of total billed charges,32% of total billed charges,490.24,1302.2,
"LENS,INTRAOCULAR(NEW TECH)",6000146,CDM,276,RC,C1780,HCPCS,OUTPATIENT,,,1829.00,731.60,,,,,,other ,not seperately reimbursable,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1097.4,60,,877.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,731.6,40,,585.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,1554.65,85,,1243.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,1280.3,70,,1024.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,585.28,32,,468.22,percent of total billed charges,32% of total billed charges,585.28,1554.65,
SUTURE 490T,6000147,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
ASPIRATING ABLATOR,6000148,CDM,272,RC,,,OUTPATIENT,,,700.00,280.00,,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420,60,,336,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,280,40,,224,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,490,70,,392,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,595,
SUTURE 664G,6000150,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TIGERSTICK,6000151,CDM,272,RC,,,OUTPATIENT,,,197.00,78.80,,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.2,60,,94.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,137.9,70,,110.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,167.45,
GEMINI CANNULA,6000153,CDM,272,RC,,,OUTPATIENT,,,133.00,53.20,,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.8,60,,63.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.2,40,,42.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,113.05,
SUTURE J329H,6000154,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MFGIA 55 TLC55,6000156,CDM,272,RC,,,OUTPATIENT,,,277.00,110.80,,,,,,other ,not seperately reimbursable,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.2,60,,132.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110.8,40,,88.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,193.9,70,,155.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,88.64,32,,70.91,percent of total billed charges,32% of total billed charges,88.64,235.45,
SUTURE MX69G,6000158,CDM,272,RC,,,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
INCISOR BLADE 4.5,6000159,CDM,272,RC,,,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
L-HOOK,6000162,CDM,272,RC,,,OUTPATIENT,,,205.00,82.00,,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123,60,,98.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82,40,,65.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,143.5,70,,114.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,174.25,
SURGIFOAM,6000163,CDM,272,RC,,,OUTPATIENT,,,289.00,115.60,,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.4,60,,138.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,115.6,40,,92.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,245.65,
BOVIE BLADE ELECTRODE E1551-6,6000164,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
HOOK PROBE,6000165,CDM,272,RC,,,OUTPATIENT,,,412.00,164.80,,,,,,other ,not seperately reimbursable,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.2,60,,197.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.8,40,,131.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,288.4,70,,230.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,131.84,32,,105.47,percent of total billed charges,32% of total billed charges,131.84,350.2,
ELECTRODE CAUTERY BLADE,6000166,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
LIGACLIP TITANIUM,6000167,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
BLADE LONG MED,6000168,CDM,272,RC,,,OUTPATIENT,,,153.00,61.20,,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.8,60,,73.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.2,40,,48.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,107.1,70,,85.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,130.05,
SUTURE J442H,6000171,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
SUTURE J849G,6000172,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
PUSH LOCK KIT,6000178,CDM,272,RC,,,OUTPATIENT,,,1300.00,520.00,,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,780,60,,624,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,520,40,,416,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,1105,85,,884,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,910,70,,728,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,1105,
FANNED PROFIX SAWBLADE,6000182,CDM,272,RC,,,OUTPATIENT,,,169.00,67.60,,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.4,60,,81.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.6,40,,54.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,118.3,70,,94.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,143.65,
SUTURE CX45D,6000183,CDM,272,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
XRAY TOWEL,6000185,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CLIP APPLIER COMPLETE,6000187,CDM,272,RC,,,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
OR TOWEL,6000192,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SCREW PEEK TENODESIS,6000194,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1122.00,448.80,,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,673.2,60,,538.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,448.8,40,,359.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,953.7,85,,762.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,785.4,70,,628.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,953.7,
BLADE LONG MED,6000195,CDM,272,RC,,,OUTPATIENT,,,103.00,41.20,,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.8,60,,49.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,72.1,70,,57.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,87.55,
BLADE MED N,6000196,CDM,272,RC,,,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,79.9,
SUTURE P8935,6000197,CDM,272,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
PUSH LOCK KIT,6000198,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,867.00,346.80,,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520.2,60,,416.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,346.8,40,,277.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,736.95,85,,589.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,606.9,70,,485.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,32,,221.95,percent of total billed charges,32% of total billed charges,277.44,736.95,
OR TOWEL FENESTRATED,6000199,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
BIOPSY FORCEP JUMBO,6000200,CDM,272,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.4,40,,16.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
SUTURE X424H,6000202,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE 8872H,6000203,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CATH UNIV 4FR,6000204,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
SHOULDER SYSTEM,6000206,CDM,272,RC,,,OUTPATIENT,,,333.00,133.20,,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.8,60,,159.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,133.2,40,,106.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,233.1,70,,186.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,106.56,283.05,
CHLORPREP APPLICATOR,6000207,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
DISP KIT,6000208,CDM,272,RC,,,OUTPATIENT,,,227.00,90.80,,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.2,60,,108.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,90.8,40,,72.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,158.9,70,,127.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,192.95,
COOLCUT,6000209,CDM,272,RC,,,OUTPATIENT,,,438.00,175.20,,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.8,60,,210.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,175.2,40,,140.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,372.3,
CRYSTAL CANNULA,6000210,CDM,272,RC,,,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
RETRIEVAL SYSTEM,6000211,CDM,272,RC,C1773,HCPCS,OUTPATIENT,,,193.00,77.20,,,,,,other ,not seperately reimbursable,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.8,60,,92.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,164.05,85,,131.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,135.1,70,,108.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,61.76,32,,49.41,percent of total billed charges,32% of total billed charges,61.76,164.05,
CARPAL TUNNEL KNIFE,6000212,CDM,272,RC,,,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
DRL SLVE 2.0MM,6000213,CDM,272,RC,,,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
SUTURE ANCHOR,6000214,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1279.00,511.60,,,,,,other ,not seperately reimbursable,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,767.4,60,,613.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,511.6,40,,409.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,1087.15,85,,869.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,895.3,70,,716.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,409.28,32,,327.42,percent of total billed charges,32% of total billed charges,409.28,1087.15,
CANNULA 8.25,6000215,CDM,272,RC,,,OUTPATIENT,,,147.00,58.80,,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,60,,70.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.8,40,,47.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,102.9,70,,82.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,124.95,
SUP MED CLAV LK PL 10H L 121MM,6000216,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3960.00,1584.00,,,,,,other ,not seperately reimbursable,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2376,60,,1900.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1584,40,,1267.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,3366,85,,2692.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,2772,70,,2217.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,1267.2,32,,1013.76,percent of total billed charges,32% of total billed charges,1267.2,3366,
POWERLOC INFUSION SET 20X.75,6000217,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
INCISOR BLADE 3.5,6000218,CDM,272,RC,,,OUTPATIENT,,,227.00,90.80,,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.2,60,,108.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,90.8,40,,72.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,158.9,70,,127.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,192.95,
INCISOR BLADE 4.0,6000220,CDM,272,RC,,,OUTPATIENT,,,153.00,61.20,,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.8,60,,73.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.2,40,,48.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,107.1,70,,85.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,32,,39.17,percent of total billed charges,32% of total billed charges,48.96,130.05,
INCISOR BLADE 4.5,6000221,CDM,272,RC,,,OUTPATIENT,,,358.00,143.20,,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.8,60,,171.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.2,40,,114.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,250.6,70,,200.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,304.3,
OATS KIT,6000222,CDM,272,RC,,,OUTPATIENT,,,2043.00,817.20,,,,,,other ,not seperately reimbursable,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1225.8,60,,980.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,817.2,40,,653.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,1736.55,85,,1389.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,1430.1,70,,1144.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,653.76,32,,523.01,percent of total billed charges,32% of total billed charges,653.76,1736.55,
INCISOR BLADE 5.5,6000223,CDM,272,RC,,,OUTPATIENT,,,171.00,68.40,,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.6,60,,82.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,68.4,40,,54.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,119.7,70,,95.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,145.35,
INCISOR BLADE 4.0,6000224,CDM,272,RC,,,OUTPATIENT,,,252.00,100.80,,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,60,,120.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,100.8,40,,80.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,176.4,70,,141.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,214.2,
PEEK CORKSCREW SUTURE ANCHOR,6000226,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1940.00,776.00,,,,,,other ,not seperately reimbursable,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1164,60,,931.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,776,40,,620.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,1649,85,,1319.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,1358,70,,1086.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,620.8,32,,496.64,percent of total billed charges,32% of total billed charges,620.8,1649,
SCREW CORK,6000229,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1161.00,464.40,,,,,,other ,not seperately reimbursable,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,696.6,60,,557.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,464.4,40,,371.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,986.85,85,,789.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,812.7,70,,650.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,371.52,32,,297.22,percent of total billed charges,32% of total billed charges,371.52,986.85,
CHLORPREP 1.5ML,6000230,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FIBERTAPE BRIDGE KIT,6000231,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1437.00,574.80,,,,,,other ,not seperately reimbursable,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,862.2,60,,689.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,574.8,40,,459.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,1221.45,85,,977.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,1005.9,70,,804.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,459.84,32,,367.87,percent of total billed charges,32% of total billed charges,459.84,1221.45,
UNIVERSAL APEC HUMERAL STEM,6000232,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,9030.00,3612.00,,3612,40,,,percent of total billed charges,40% of total billed charges,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5418,60,,4334.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3612,40,,2889.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,7675.5,85,,6140.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,6321,70,,5056.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,2889.6,32,,2311.68,percent of total billed charges,32% of total billed charges,2889.6,7675.5,
UNIVERSAL VAULTLOCK GLENOID,6000233,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6300.00,2520.00,,2520,40,,,percent of total billed charges,40% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3780,60,,3024,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2520,40,,2016,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,5355,85,,4284,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,4410,70,,3528,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,5355,
USP II HUMERAL HEAD,6000234,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,4831.00,1932.40,,,,,,other ,not seperately reimbursable,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2898.6,60,,2318.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1932.4,40,,1545.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,4106.35,85,,3285.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,3381.7,70,,2705.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,1545.92,32,,1236.74,percent of total billed charges,32% of total billed charges,1545.92,4106.35,
PIN SET UNIVERSAL,6000235,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1100.00,440.00,,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,660,60,,528,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,440,40,,352,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,770,70,,616,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,935,
DW OUTFLOW CASSETTE/TUBE SET,6000236,CDM,272,RC,,,OUTPATIENT,,,158.00,63.20,,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.8,60,,75.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,63.2,40,,50.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,110.6,70,,88.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,134.3,
BURR OVAL,6000237,CDM,272,RC,,,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
UNIVERSAL SUTURE CUP,6000238,CDM,278,RC,,,OUTPATIENT,,,2791.00,1116.40,,,,,,other ,not seperately reimbursable,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1674.6,60,,1339.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1116.4,40,,893.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,2372.35,85,,1897.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,1953.7,70,,1562.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,893.12,32,,714.5,percent of total billed charges,32% of total billed charges,893.12,2372.35,
UNIVERSAL SUTURE CUP,6000239,CDM,278,RC,,,OUTPATIENT,,,4909.00,1963.60,,,,,,other ,not seperately reimbursable,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945.4,60,,2356.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1963.6,40,,1570.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,4172.65,85,,3338.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,3436.3,70,,2749.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,1570.88,32,,1256.7,percent of total billed charges,32% of total billed charges,1570.88,4172.65,
HIP ARTHROSCOPY KIT MSTR AR-6526S,6000240,CDM,272,RC,,,OUTPATIENT,,,1768.25,707.30,,,,,,other ,not seperately reimbursable,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.95,60,,848.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,707.3,40,,565.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,1503.01,85,,1202.41,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,1237.78,70,,990.22,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,565.84,32,,452.67,percent of total billed charges,32% of total billed charges,565.84,1503.01,
CAPSULOTOMY BLADE AR-6527-03,6000241,CDM,272,RC,,,OUTPATIENT,,,572.00,228.80,,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,343.2,60,,274.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.8,40,,183.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,486.2,85,,388.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,400.4,70,,320.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,486.2,
APOLLO AR-9865,6000242,CDM,272,RC,,,OUTPATIENT,,,1023.00,409.20,,,,,,other ,not seperately reimbursable,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,613.8,60,,491.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,409.2,40,,327.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,869.55,85,,695.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,716.1,70,,572.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,327.36,32,,261.89,percent of total billed charges,32% of total billed charges,327.36,869.55,
PORTAL SKID AR-4505,6000243,CDM,272,RC,,,OUTPATIENT,,,177.38,70.95,,,,,,other ,not seperately reimbursable,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.43,60,,85.14,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,70.95,40,,56.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,150.77,85,,120.62,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,124.17,70,,99.34,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,56.76,32,,45.41,percent of total billed charges,32% of total billed charges,56.76,150.77,
SUTURE TENSION/CUTTER  AR-5815,6000244,CDM,272,RC,,,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
MODULAR POST PORTAL SKID AR-9582-25,6000245,CDM,272,RC,,,OUTPATIENT,,,3988.00,1595.20,,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2392.8,60,,1914.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1595.2,40,,1276.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,3389.8,85,,2711.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,2791.6,70,,2233.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,3389.8,
BONE GRAFT DRILL 8MM,6000246,CDM,272,RC,,,OUTPATIENT,,,676.00,270.40,,,,,,other ,not seperately reimbursable,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.6,60,,324.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,270.4,40,,216.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,574.6,85,,459.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,473.2,70,,378.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,216.32,32,,173.06,percent of total billed charges,32% of total billed charges,216.32,574.6,
NRV BLK SPNL ACCESSORY,6001350,CDM,360,RC,64412,HCPCS,OUTPATIENT,,,763.00,305.20,,3000,100,,,case rate,pays based on per visit rate,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.8,60,,366.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,305.2,40,,244.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,3000,
"NRV BLK BRACHIAL PLEXUS,SNGL",6001351,CDM,360,RC,64415,HCPCS,OUTPATIENT,,,763.00,305.20,,3000,100,,,case rate,pays based on per visit rate,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,457.8,60,,366.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,141.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,141.99,3000,
NRV BLK ILIOHNG/ILIOHYPO,6001352,CDM,360,RC,64425,HCPCS,OUTPATIENT,,,763.00,305.20,,3000,100,,,case rate,pays based on per visit rate,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.8,60,,366.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,140.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,140.04,3000,
"NRV BLK SCIATIC, SNGL",6001353,CDM,360,RC,64445,HCPCS,OUTPATIENT,,,1443.00,577.20,,3000,100,,,case rate,pays based on per visit rate,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,865.8,60,,692.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,157.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,1226.55,85,,981.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,157.5,3000,
"NRV BLK FEMORAL, SNGL",6001354,CDM,360,RC,64447,HCPCS,OUTPATIENT,,,763.00,305.20,,3000,100,,,case rate,pays based on per visit rate,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.8,60,,366.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,111.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,111.65,3000,
NRV BLK PERPH NRV OR BRNCH,6001355,CDM,360,RC,64450,HCPCS,OUTPATIENT,,,763.00,305.20,,3000,100,,,case rate,pays based on per visit rate,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.8,60,,366.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,95.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,95.7,3000,
"NRV BLK EPIDURAL,SINGL LVL C/T",6001356,CDM,360,RC,64479,HCPCS,OUTPATIENT,,,1443.00,577.20,,3000,100,,,case rate,pays based on per visit rate,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,865.8,60,,692.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,335.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,1226.55,85,,981.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,335.71,3000,
"NRV BLK EPIDURAL,SINGL LVL L/S",6001357,CDM,360,RC,64483,HCPCS,OUTPATIENT,,,1443.00,577.20,,3000,100,,,case rate,pays based on per visit rate,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,865.8,60,,692.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,1226.55,85,,981.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,461.76,32,,369.41,percent of total billed charges,32% of total billed charges,311.29,3000,
ATTACHED PEDICLE GRAFT-TRUNK 10SQ CM,6014000,CDM,450,RC,14000,HCPCS,OUTPATIENT,,,1357.00,542.80,,,,,,other ,not seperately reimbursable,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,814.2,60,,651.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,804.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,1153.45,85,,922.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,949.9,70,,759.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,434.24,32,,347.39,percent of total billed charges,32% of total billed charges,419,1153.45,
DESTRUCTION OF LESION UP TO 14,6017110,CDM,360,RC,17110,HCPCS,OUTPATIENT,,,174.00,69.60,,3000,100,,,case rate,pays based on per visit rate,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,140.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,3000,
RT ARTHROCENTESIS,6020610,CDM,360,RC,20610,HCPCS,OUTPATIENT,,,354.00,141.60,,3000,100,,,case rate,pays based on per visit rate,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.4,60,,169.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,300.9,85,,240.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,247.8,70,,198.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,82.64,3000,
LT ARTHROCENTESIS,6020611,CDM,510,RC,20610,HCPCS,OUTPATIENT,,,354.00,141.60,,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.4,60,,169.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,300.9,85,,240.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,247.8,70,,198.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,82.64,300.9,
BILATERIAL ARTHROCENTESIS,6020612,CDM,510,RC,20610,HCPCS,OUTPATIENT,,,354.00,141.60,,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.4,60,,169.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,300.9,85,,240.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,247.8,70,,198.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,82.64,300.9,
"LARYNGOSCOPY, DIAGNOSTIC",6031525,CDM,750,RC,31525,HCPCS,OUTPATIENT,,,2138.00,855.20,,3000,100,,,case rate,pays based on per visit rate,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1282.8,60,,1026.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,318.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,1817.3,85,,1453.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,684.16,32,,547.33,percent of total billed charges,32% of total billed charges,312,3000,
"LARYNGOSCOPY, DIRECT W/ BIOPSY",6031535,CDM,750,RC,31535,HCPCS,OUTPATIENT,,,3305.00,1322.00,,3000,100,,,case rate,pays based on per visit rate,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1983,60,,1586.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,241.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,2809.25,85,,2247.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,2313.5,70,,1850.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,1057.6,32,,846.08,percent of total billed charges,32% of total billed charges,241.99,3000,
"THORACENTESIS NDLE, W/O IMAGING",6032554,CDM,360,RC,32554,HCPCS,OUTPATIENT,,,1372.00,548.80,,3000,100,,,case rate,pays based on per visit rate,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,823.2,60,,658.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,301.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,1166.2,85,,932.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,960.4,70,,768.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,301.95,3000,
COSMETIC ADD ON FEE PER 15 MIN,6035451,CDM,360,RC,,,OUTPATIENT,,,392.00,156.80,,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.2,60,,188.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.8,40,,125.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,274.4,70,,219.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,333.2,
WITH DIRECT PLACEMENT OF PEG,6043246,CDM,750,RC,43246,HCPCS,OUTPATIENT,,,3205.00,1282.00,,3000,100,,,case rate,pays based on per visit rate,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1923,60,,1538.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,258.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2724.25,85,,2179.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2243.5,70,,1794.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,258.98,3000,
ESOPHAGEAL DILATION W/ BALLOON>30MM,6043458,CDM,750,RC,43214,HCPCS,OUTPATIENT,,,3292.00,1316.80,,3000,100,,,case rate,pays based on per visit rate,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1975.2,60,,1580.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,247.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2798.2,85,,2238.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2304.4,70,,1843.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,247.9,3000,
OPSU SPEC COL IMPLANTED PORT,6043459,CDM,361,RC,36591,HCPCS,OUTPATIENT,,,236.00,94.40,,3000,100,,,case rate,pays based on per visit rate,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,32.3,3000,
ILESCOPY W/O BIOPSY,6044376,CDM,750,RC,44376,HCPCS,OUTPATIENT,,,3292.00,1316.80,,3000,100,,,case rate,pays based on per visit rate,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1975.2,60,,1580.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,363.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2798.2,85,,2238.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2304.4,70,,1843.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,363.14,3000,
ILESCOPY W/BIOPSY,6044377,CDM,750,RC,44377,HCPCS,OUTPATIENT,,,3292.00,1316.80,,3000,100,,,case rate,pays based on per visit rate,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1975.2,60,,1580.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,382.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2798.2,85,,2238.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2304.4,70,,1843.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,382.18,3000,
PROCTOSIGMOIDSCOPY,6045300,CDM,750,RC,45300,HCPCS,OUTPATIENT,,,1653.00,661.20,,3000,100,,,case rate,pays based on per visit rate,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,991.8,60,,793.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,162.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,1405.05,85,,1124.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,1157.1,70,,925.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,528.96,32,,423.17,percent of total billed charges,32% of total billed charges,162.48,3000,
SIGMOIDSCOPY FLEXIABLE,6045330,CDM,750,RC,45330,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,234.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,234.88,3000,
ANOSCOPY,6046600,CDM,750,RC,46600,HCPCS,OUTPATIENT,,,173.00,69.20,,3000,100,,,case rate,pays based on per visit rate,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,152.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,3000,
ANAL BIOPSY,6046606,CDM,750,RC,46606,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,360.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,360.24,3000,
CYCTOURETHROSCOPY COMPLICATED,6052315,CDM,750,RC,52315,HCPCS,OUTPATIENT,,,3528.00,1411.20,,3000,100,,,case rate,pays based on per visit rate,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2116.8,60,,1693.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,599.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,2998.8,85,,2399.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,2469.6,70,,1975.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,419,3000,
LITHOPLAPAXY COMPLICATED OR >2.5CM,6052318,CDM,750,RC,52318,HCPCS,OUTPATIENT,,,3528.00,1411.20,,3000,100,,,case rate,pays based on per visit rate,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2116.8,60,,1693.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,604.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,2998.8,85,,2399.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,2469.6,70,,1975.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,1128.96,32,,903.17,percent of total billed charges,32% of total billed charges,419,3000,
PELVIC EXAM UNDER ANES,6057410,CDM,750,RC,57410,HCPCS,OUTPATIENT,,,5103.00,2041.20,,3000,100,,,case rate,pays based on per visit rate,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3061.8,60,,2449.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,136.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,4337.55,85,,3470.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,3572.1,70,,2857.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,1632.96,32,,1306.37,percent of total billed charges,32% of total billed charges,136.73,4337.55,
CYTO SMEAR F/W/B CONCENTRATION,6088108,CDM,310,RC,88108,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,50.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
CYTO SMEAR F/W/B  THIN PREP,6088112,CDM,310,RC,88112,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
"CYTOPATHOLOGY, CERVICAL/VAGINAL",6088113,CDM,310,RC,88141,HCPCS,OUTPATIENT,,,56.60,22.64,,,,,,other ,not seperately reimbursable,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.96,60,,27.17,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,48.11,85,,38.49,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,39.62,70,,31.7,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,18.11,32,,14.49,percent of total billed charges,32% of total billed charges,18.11,48.11,
IMMOBILIZER 21IN,6088206,CDM,274,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
SLING ULTRA LARGE,6088208,CDM,272,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
NEEDLE HUBER 1 1/4,6088210,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
NEEDLE HUBER 20X3/4,6088211,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
TRAPEZIECTOMY TOOL,6088212,CDM,272,RC,,,OUTPATIENT,,,985.00,394.00,,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,591,60,,472.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,394,40,,315.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,837.25,85,,669.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,689.5,70,,551.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,837.25,
SURGICAL PATHOLOGY LEVEL 1,6088300,CDM,310,RC,88300,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,272,,,fee schedule,272% of BCBS fee schedule,27.2,272,,,fee schedule,272% of BCBS fee schedule,27.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
SURGICAL PATHOLOGY LEVEL 2,6088302,CDM,310,RC,88302,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,38.08,272,,,fee schedule,272% of BCBS fee schedule,38.08,272,,,fee schedule,272% of BCBS fee schedule,38.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
SURGICAL PATHOLOGY LEVEL 3,6088304,CDM,310,RC,88304,HCPCS,OUTPATIENT,,,107.00,42.80,,36.86,100,,,fee schedule,100% of Aetna fee schedule,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,46.24,272,,,fee schedule,272% of BCBS fee schedule,46.24,272,,,fee schedule,272% of BCBS fee schedule,46.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
SURGICAL PATHOLOGY LEVEL 4,6088305,CDM,310,RC,88305,HCPCS,OUTPATIENT,,,204.00,81.60,,62.08,100,,,fee schedule,100% of Aetna fee schedule,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,242.08,272,,,fee schedule,272% of BCBS fee schedule,242.08,272,,,fee schedule,272% of BCBS fee schedule,242.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,122.4,60,,97.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,40.83,242.08,
SURGICAL PATHOLOGY LEVEL 5,6088307,CDM,310,RC,88307,HCPCS,OUTPATIENT,,,484.00,193.60,,147.6,100,,,fee schedule,100% of Aetna fee schedule,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,111.52,272,,,fee schedule,272% of BCBS fee schedule,111.52,272,,,fee schedule,272% of BCBS fee schedule,111.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,245.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,111.52,411.4,
SURGICAL PATHOLOGY LEVEL 6,6088309,CDM,310,RC,88309,HCPCS,OUTPATIENT,,,832.00,332.80,,,,,,other ,not seperately reimbursable,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,133.28,272,,,fee schedule,272% of BCBS fee schedule,133.28,272,,,fee schedule,272% of BCBS fee schedule,133.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,499.2,60,,399.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,349.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,582.4,70,,465.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,266.24,32,,212.99,percent of total billed charges,32% of total billed charges,133.28,707.2,
CYTO SMEAR F/W/B,6088310,CDM,310,RC,88104,HCPCS,OUTPATIENT,,,175.00,70.00,,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,48.14,148.75,
DECALCIFICATION,6088311,CDM,310,RC,88311,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
SPECIAL STAIN (OR),6088312,CDM,310,RC,88312,HCPCS,OUTPATIENT,,,255.00,102.00,,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153,60,,122.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,103.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,178.5,70,,142.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,216.75,
SPECIAL STAIN GROUP 2,6088313,CDM,310,RC,88313,HCPCS,OUTPATIENT,,,74.00,29.60,,46.98,100,,,fee schedule,100% of Aetna fee schedule,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,82.66,
FROZEN SECTION (OR),6088331,CDM,310,RC,88331,HCPCS,OUTPATIENT,,,295.00,118.00,,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177,60,,141.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,48.95,250.75,
ADD'L FROZEN SECTION X EA,6088332,CDM,310,RC,88332,HCPCS,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,29.05,115.6,
IHC STAIN ADDNL,6088341,CDM,310,RC,88341,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,62.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,62.5,
IHC STAIN INITIAL,6088342,CDM,310,RC,88342,HCPCS,OUTPATIENT,,,318.00,127.20,,69.69,100,,,fee schedule,100% of Aetna fee schedule,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.8,60,,152.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,222.6,70,,178.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,69.69,270.3,
"ED INJ IM OF TETANUS, DIPHTHERIA TOXIOD",6090718,CDM,636,RC,90702,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
ED INFUSION IV THERAPY-1ST HR,6090780,CDM,262,RC,96365,HCPCS,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,82.65,257.55,
INFUSION IV THERAPY-EA ADD'L HR,6090781,CDM,262,RC,96366,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,25.86,72.25,
"ED INJ,IM THERAPEUTIC",6090782,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,17.71,62.9,
"ED INJ,INTRA PUSH IV",6090784,CDM,450,RC,96374,HCPCS,OUTPATIENT,,,506.00,202.40,,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303.6,60,,242.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,354.2,70,,283.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,48.01,430.1,
"TX INJ,IM THERAPEUTIC",6096372,CDM,761,RC,96372,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,17.71,62.9,
ED INFUSION INTRAVENOUS THERAPY-1ST HR,6099760,CDM,450,RC,96360,HCPCS,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,41.9,157.25,
ED INFUSION IV THERAPY ADD'L HR,6099761,CDM,262,RC,96361,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,15.88,51.85,
ED INJ EA ADD'L DRUG INTRA 2,6099775,CDM,450,RC,96375,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,19.56,70.55,
STAPLER-HEMORRID PPH03,6100100,CDM,272,RC,,,OUTPATIENT,,,1093.00,437.20,,,,,,other ,not seperately reimbursable,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,655.8,60,,524.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,929.05,85,,743.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,765.1,70,,612.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,349.76,32,,279.81,percent of total billed charges,32% of total billed charges,349.76,929.05,
CRE 5850,6100101,CDM,272,RC,C1726,HCPCS,OUTPATIENT,,,605.00,242.00,,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363,60,,290.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,514.25,85,,411.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,423.5,70,,338.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,514.25,
CloseSure KIT,6100104,CDM,272,RC,,,OUTPATIENT,,,400.00,160.00,,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,32,,102.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,60,,192,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,32,,102.4,percent of total billed charges,32% of total billed charges,280,70,,224,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,340,
SUTURE U204H,6100105,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
COBLATOR II,6100110,CDM,272,RC,,,OUTPATIENT,,,647.00,258.80,,,,,,other ,not seperately reimbursable,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.2,60,,310.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,549.95,85,,439.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,452.9,70,,362.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,207.04,32,,165.63,percent of total billed charges,32% of total billed charges,207.04,549.95,
ELECTRODE COATED2.84,6100111,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
ELECTRODE COATED 6.5,6100112,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SUTURE X872H,6100116,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CROSS BLADE,6100118,CDM,272,RC,,,OUTPATIENT,,,228.00,91.20,,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.8,60,,109.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,159.6,70,,127.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,193.8,
CRE 5848,6100119,CDM,272,RC,C1726,HCPCS,OUTPATIENT,,,279.00,111.60,,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.4,60,,133.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,195.3,70,,156.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,237.15,
MAX BX FCPS,6100120,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
G-TUBE LOW PROFILE 18FR,6100121,CDM,272,RC,,,OUTPATIENT,,,272.00,108.80,,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,60,,130.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,190.4,70,,152.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,231.2,
BEAVER BLADE,6100122,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
HEATER PROBE,6100123,CDM,272,RC,,,OUTPATIENT,,,768.00,307.20,,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,60,,368.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,537.6,70,,430.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,652.8,
DRAIN 7 FLAT,6100124,CDM,272,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
DRAIN 15 ROUND,6100125,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
CORE BIOPSY NEEDLE,6100126,CDM,272,RC,,,OUTPATIENT,,,199.00,79.60,,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.4,60,,95.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,169.15,
G-TUBE LOW PROFILE 16FR,6100127,CDM,272,RC,,,OUTPATIENT,,,238.00,95.20,,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.8,60,,114.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,166.6,70,,133.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,202.3,
SUTURE Y333H,6100128,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SUTURE Y341H,6100129,CDM,272,RC,,,OUTPATIENT,,,6.25,2.50,,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.75,60,,3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,5.31,85,,4.25,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,4.38,70,,3.5,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,5.31,
SUTURE Y944H,6100130,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HOT BIOPSY FORCEPS,6100132,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
ROTATABLE SNARE,6100133,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
SAME AS #6100693,6100134,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
BLADE MD NARROW,6100136,CDM,272,RC,,,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,79.9,
CRE 5849,6100137,CDM,272,RC,C1726,HCPCS,OUTPATIENT,,,605.00,242.00,,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363,60,,290.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,514.25,85,,411.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,423.5,70,,338.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,32,,154.88,percent of total billed charges,32% of total billed charges,193.6,514.25,
SUTURE 1915G,6100148,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SUTURE 802H,6100151,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SUTURE 803H,6100152,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SUTURE 8411H,6100153,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SUTURE MCP494G,6100155,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SUTURE G181H,6100156,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SUTURE G122H,6100158,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SUTURE U256H,6100160,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SUTURE 635H,6100161,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SUTURE 636H,6100162,CDM,272,RC,,,OUTPATIENT,,,8.70,3.48,,,,,,other ,not seperately reimbursable,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.22,60,,4.18,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,7.4,85,,5.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,6.09,70,,4.87,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,2.78,32,,2.22,percent of total billed charges,32% of total billed charges,2.78,7.4,
DRILL BIT,6100164,CDM,272,RC,,,OUTPATIENT,,,181.00,72.40,,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.6,60,,86.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,126.7,70,,101.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,153.85,
CATHTHER-OPEN ENDED,6100165,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
TROCAR CFB73,6100172,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
ENDO RELOAD 45W  TR45W,6100174,CDM,272,RC,,,OUTPATIENT,,,411.00,164.40,,,,,,other ,not seperately reimbursable,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.6,60,,197.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,349.35,85,,279.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,287.7,70,,230.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,131.52,32,,105.22,percent of total billed charges,32% of total billed charges,131.52,349.35,
ENDO RELOAD 45B  6R45B,6100176,CDM,272,RC,,,OUTPATIENT,,,425.00,170.00,,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,255,60,,204,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,297.5,70,,238,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,361.25,
TROCAR CTR01,6100181,CDM,272,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
STABLIZER CONE 12MM  C0707,6100185,CDM,272,RC,,,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
INSUFFLATION 120MM NEEDLE  C2201,6100186,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
DRAPE TAPE    3524,6100189,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRAPE SPLIT     KM89331,6100191,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
STAPLER ENDO 45W   ATW45,6100192,CDM,272,RC,,,OUTPATIENT,,,700.00,280.00,,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420,60,,336,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,490,70,,392,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,595,
BLADE AR-600-011S,6100198,CDM,272,RC,,,OUTPATIENT,,,257.00,102.80,,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.2,60,,123.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,218.45,85,,174.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,179.9,70,,143.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,82.24,218.45,
SCREW,6100199,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
PACK KNEE   KM8434,6100200,CDM,272,RC,,,OUTPATIENT,,,139.00,55.60,,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.4,60,,66.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,97.3,70,,77.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,118.15,
SCREW CORTEX 3.5 14MM   204.814,6100201,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
SUTURE J978H,6100203,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J603H,6100204,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PLATE 6 HOLE,6100205,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,704.00,281.60,,,,,,other ,not seperately reimbursable,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422.4,60,,337.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,598.4,85,,478.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,492.8,70,,394.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,225.28,32,,180.22,percent of total billed charges,32% of total billed charges,225.28,598.4,
SUTURE 699G,6100208,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
INTELISET TUBNG   7204727,6100212,CDM,272,RC,,,OUTPATIENT,,,369.00,147.60,,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.4,60,,177.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,147.6,40,,118.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,313.65,
LIGACLIP LT400,6100215,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
SUTURE 9003G,6100227,CDM,272,RC,,,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
SUTURE J974G,6100228,CDM,272,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
SUTURE 1732G,6100229,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
SUTURE J504G,6100230,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SUTURE 687G,6100231,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SUTURE 8695G,6100232,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SUTURE 1669H,6100233,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SUTURE GG-123,6100234,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SUTURE 8410H,6100235,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SUTURE D-6958,6100236,CDM,272,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.4,40,,16.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
SUTURE D7793,6100238,CDM,272,RC,,,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36,40,,28.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
POLARIS ULTRA,6100239,CDM,272,RC,,,OUTPATIENT,,,482.00,192.80,,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.2,60,,231.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,192.8,40,,154.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,409.7,85,,327.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,337.4,70,,269.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,409.7,
BONE WAX W31G,6100240,CDM,278,RC,C1889,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
MAYO CATGUT,6100250,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SPARC SLING,6100251,CDM,278,RC,C1771,HCPCS,OUTPATIENT,,,3190.00,1276.00,,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1914,60,,1531.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1276,40,,1020.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,2711.5,85,,2169.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,2233,70,,1786.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,2711.5,
SUTURE X412H,6100253,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE Y493G,6100254,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
SUTURE K833H,6100256,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE A186H,6100266,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MESH PCDW1,6100267,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,6053.00,2421.20,,2421.2,40,,,percent of total billed charges,40% of total billed charges,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3631.8,60,,2905.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2421.2,40,,1936.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,5145.05,85,,4116.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,4237.1,70,,3389.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,1936.96,32,,1549.57,percent of total billed charges,32% of total billed charges,1936.96,5145.05,
MESH PCDM1,6100268,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2000.00,800.00,,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1200,60,,960,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,800,40,,640,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,1700,85,,1360,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,1400,70,,1120,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,640,1700,
MESH PCDG1,6100269,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,3600.00,1440.00,,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,32,,921.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,60,,1728,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1440,40,,1152,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,32,,921.6,percent of total billed charges,32% of total billed charges,2520,70,,2016,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,3060,
MESH PCDH1,6100270,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,5700.00,2280.00,,2280,40,,,percent of total billed charges,40% of total billed charges,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3420,60,,2736,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2280,40,,1824,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,4845,85,,3876,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,3990,70,,3192,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,1824,32,,1459.2,percent of total billed charges,32% of total billed charges,1824,4845,
SUTURE 699H,6100272,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
WEBRIL 6  TER,6100277,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MARKER SKIN NS,6100291,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STAPLER 6R45M,6100293,CDM,272,RC,,,OUTPATIENT,,,336.00,134.40,,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,60,,161.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,134.4,40,,107.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,235.2,70,,188.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,285.6,
BLADE OSCILATING,6100299,CDM,272,RC,,,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
EXTRACTOR COOK,6100302,CDM,272,RC,,,OUTPATIENT,,,639.00,255.60,,,,,,other ,not seperately reimbursable,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383.4,60,,306.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,255.6,40,,204.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,543.15,85,,434.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,447.3,70,,357.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,204.48,32,,163.58,percent of total billed charges,32% of total billed charges,204.48,543.15,
PIN THREADED TIP,6100303,CDM,272,RC,,,OUTPATIENT,,,282.00,112.80,,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.2,60,,135.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.8,40,,90.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,239.7,85,,191.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,197.4,70,,157.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,90.24,239.7,
K WIRE .062X4,6100311,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
SUTURE 47T,6100313,CDM,272,RC,,,OUTPATIENT,,,62.00,24.80,,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.2,60,,29.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,43.4,70,,34.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,52.7,
SOFT FORM REGULAR,6100314,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
RUMAN RR600,6100316,CDM,272,RC,,,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
SPAC SLING SYSTEM,6100318,CDM,278,RC,C1771,HCPCS,OUTPATIENT,,,2571.00,1028.40,,,,,,other ,not seperately reimbursable,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1542.6,60,,1234.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1028.4,40,,822.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,2185.35,85,,1748.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,1799.7,70,,1439.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,822.72,32,,658.18,percent of total billed charges,32% of total billed charges,822.72,2185.35,
STRYKE FLOW II,6100320,CDM,272,RC,,,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
FEMORAL SYSTEM,6100366,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6089.00,2435.60,,2435.6,40,,,percent of total billed charges,40% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3653.4,60,,2922.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2435.6,40,,1948.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,5175.65,85,,4140.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,4262.3,70,,3409.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,5175.65,
CATH EMBOLE 5FR,6100370,CDM,272,RC,C1757,HCPCS,OUTPATIENT,,,218.00,87.20,,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.8,60,,104.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.2,40,,69.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,152.6,70,,122.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,185.3,
COLLAGEN PLUG,6100454,CDM,278,RC,C1889,HCPCS,OUTPATIENT,,,2723.00,1089.20,,,,,,other ,not seperately reimbursable,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1633.8,60,,1307.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1089.2,40,,871.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,2314.55,85,,1851.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,1906.1,70,,1524.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,871.36,32,,697.09,percent of total billed charges,32% of total billed charges,871.36,2314.55,
POLARIS URETHAL 6FR,6100458,CDM,272,RC,,,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
INTRODUCER  AIR GUARD,6100459,CDM,272,RC,,,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
INTRODUCER  AIR GUARD,6100460,CDM,272,RC,,,OUTPATIENT,,,226.00,90.40,,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.6,60,,108.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,90.4,40,,72.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,192.1,
#PDO 36X36,6100468,CDM,272,RC,,,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
SCREW ACL TIGHTROPE,6100469,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,880.00,352.00,,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,528,60,,422.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,352,40,,281.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,748,85,,598.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,616,70,,492.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,748,
SCREW GRAFT BOLT 9MM,6100470,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1554.00,621.60,,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.4,60,,745.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,621.6,40,,497.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,1087.8,70,,870.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,1320.9,
SCREW TIGHTROPE PIN,6100471,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,492.00,196.80,,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295.2,60,,236.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,196.8,40,,157.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,418.2,85,,334.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,344.4,70,,275.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,157.44,418.2,
LOW PROFILE 9MM,6100472,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,767.00,306.80,,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.2,60,,368.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,306.8,40,,245.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,651.95,85,,521.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,536.9,70,,429.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,651.95,
ACL DISP KIT,6100473,CDM,272,RC,,,OUTPATIENT,,,601.00,240.40,,,,,,other ,not seperately reimbursable,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.6,60,,288.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240.4,40,,192.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,510.85,85,,408.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,420.7,70,,336.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,192.32,32,,153.86,percent of total billed charges,32% of total billed charges,192.32,510.85,
RETRO CUTTER,6100474,CDM,272,RC,,,OUTPATIENT,,,770.00,308.00,,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,462,60,,369.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,308,40,,246.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,539,70,,431.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,654.5,
RETRO PIN,6100475,CDM,272,RC,,,OUTPATIENT,,,505.00,202.00,,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303,60,,242.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,202,40,,161.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,353.5,70,,282.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,429.25,
FIBERWIRE,6100476,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
FIBERWIRE #2,6100477,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
OPES PROBE,6100478,CDM,272,RC,,,OUTPATIENT,,,504.00,201.60,,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,302.4,60,,241.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,201.6,40,,161.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,428.4,85,,342.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,352.8,70,,282.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,428.4,
FIBERLOOP,6100479,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,289.00,115.60,,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.4,60,,138.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,115.6,40,,92.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,245.65,
DRILLS ACCESS,6100481,CDM,272,RC,,,OUTPATIENT,,,1240.00,496.00,,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,744,60,,595.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,496,40,,396.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,1054,85,,843.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,868,70,,694.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,1054,
NEEDLE SCORPION,6100482,CDM,272,RC,,,OUTPATIENT,,,894.00,357.60,,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,536.4,60,,429.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,357.6,40,,286.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,759.9,
SWIVELOCK 4.75 BC,6100483,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2269.00,907.60,,,,,,other ,not seperately reimbursable,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1361.4,60,,1089.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,907.6,40,,726.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,1928.65,85,,1542.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,1588.3,70,,1270.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,726.08,32,,580.86,percent of total billed charges,32% of total billed charges,726.08,1928.65,
FIBERTAPE 2MM,6100484,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,289.00,115.60,,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.4,60,,138.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,115.6,40,,92.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,245.65,
TIP IRRIGATION FEMORAL,6100485,CDM,272,RC,,,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,127.5,
DRILL BIT QUICK RELEASE,6100486,CDM,272,RC,,,OUTPATIENT,,,264.00,105.60,,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,60,,126.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.6,40,,84.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,184.8,70,,147.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,224.4,
PATELLA BIOMET SERIES,6100488,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,825.00,330.00,,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495,60,,396,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,330,40,,264,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,701.25,85,,561,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,577.5,70,,462,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,701.25,
SPEEDBRIDGE BC KIT,6100489,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,5264.00,2105.60,,2105.6,40,,,percent of total billed charges,40% of total billed charges,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3158.4,60,,2526.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2105.6,40,,1684.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,4474.4,85,,3579.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,3684.8,70,,2947.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,1684.48,32,,1347.58,percent of total billed charges,32% of total billed charges,1684.48,4474.4,
PS TIBIAL BEARING,6100490,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6800.00,2720.00,,2720,40,,,percent of total billed charges,40% of total billed charges,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4080,60,,3264,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2720,40,,2176,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,5780,85,,4624,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,4760,70,,3808,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,2176,32,,1740.8,percent of total billed charges,32% of total billed charges,2176,5780,
TIBIAK CRUCIATE WING,6100491,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,2286.00,914.40,,,,,,other ,not seperately reimbursable,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1371.6,60,,1097.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,914.4,40,,731.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,1943.1,85,,1554.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,1600.2,70,,1280.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,731.52,32,,585.22,percent of total billed charges,32% of total billed charges,731.52,1943.1,
TOGA GOWN,6100497,CDM,272,RC,,,OUTPATIENT,,,307.00,122.80,,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.2,60,,147.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,122.8,40,,98.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,214.9,70,,171.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,260.95,
CBC CONSTAVAC W/DRAIN,6100498,CDM,272,RC,,,OUTPATIENT,,,629.00,251.60,,,,,,other ,not seperately reimbursable,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.4,60,,301.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,251.6,40,,201.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,534.65,85,,427.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,440.3,70,,352.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,201.28,32,,161.02,percent of total billed charges,32% of total billed charges,201.28,534.65,
REVOLUTION CEMENT MIXER,6100499,CDM,272,RC,,,OUTPATIENT,,,360.00,144.00,,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,60,,172.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144,40,,115.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,252,70,,201.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,306,
MIX EVAC,6100501,CDM,272,RC,,,OUTPATIENT,,,160.00,64.00,,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
CEMENT DISP,6100502,CDM,272,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
INTERPULSE IRRIG,6100503,CDM,272,RC,,,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
SUTURE RETRIEVER,6100507,CDM,272,RC,,,OUTPATIENT,,,247.00,98.80,,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.2,60,,118.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,98.8,40,,79.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,172.9,70,,138.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,209.95,
SAGITTAL BLADE SYSTEM 6,6100509,CDM,272,RC,,,OUTPATIENT,,,244.00,97.60,,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,60,,117.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,97.6,40,,78.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,170.8,70,,136.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,207.4,
SAGITTAL BLADE SYSTEM 6,6100510,CDM,272,RC,,,OUTPATIENT,,,244.00,97.60,,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,60,,117.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,97.6,40,,78.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,170.8,70,,136.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,207.4,
SAGITTAL BLADE SYSTEM 6,6100511,CDM,272,RC,,,OUTPATIENT,,,163.00,65.20,,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,60,,78.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.2,40,,52.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,114.1,70,,91.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,138.55,
SAGITTAL BLADE SYSTEM 6,6100512,CDM,272,RC,,,OUTPATIENT,,,244.00,97.60,,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,60,,117.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,97.6,40,,78.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,170.8,70,,136.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,32,,62.46,percent of total billed charges,32% of total billed charges,78.08,207.4,
SUTURE ANCHOR SCREW,6100516,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1673.00,669.20,,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1003.8,60,,803.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,669.2,40,,535.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,1422.05,
INSTYRUMENT SET,6100517,CDM,272,RC,,,OUTPATIENT,,,1238.00,495.20,,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,742.8,60,,594.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,495.2,40,,396.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,1052.3,85,,841.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,866.6,70,,693.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,1052.3,
SUTURE Y936H,6100518,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SUTURE J269H,6100519,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
THIN PATELLA BIOMET,6100520,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,1276.00,510.40,,,,,,other ,not seperately reimbursable,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,765.6,60,,612.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,510.4,40,,408.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,1084.6,85,,867.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,893.2,70,,714.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,408.32,32,,326.66,percent of total billed charges,32% of total billed charges,408.32,1084.6,
CEMENT,6100521,CDM,272,RC,,,OUTPATIENT,,,146.00,58.40,,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.6,60,,70.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,102.2,70,,81.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,124.1,
E1 HUMERAL BEARING,6100527,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,5500.00,2200.00,,2200,40,,,percent of total billed charges,40% of total billed charges,1760,32,,1408,percent of total billed charges,32% of total billed charges,1760,32,,1408,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3300,60,,2640,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2200,40,,1760,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1760,32,,1408,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,32,,1408,percent of total billed charges,32% of total billed charges,4675,85,,3740,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,32,,1408,percent of total billed charges,32% of total billed charges,1760,32,,1408,percent of total billed charges,32% of total billed charges,3850,70,,3080,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1760,32,,1408,percent of total billed charges,32% of total billed charges,1760,32,,1408,percent of total billed charges,32% of total billed charges,1760,4675,
PATELLA,6100528,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,2100.00,840.00,,,,,,other ,not seperately reimbursable,672,32,,537.6,percent of total billed charges,32% of total billed charges,672,32,,537.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1260,60,,1008,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,840,40,,672,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,672,32,,537.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672,32,,537.6,percent of total billed charges,32% of total billed charges,1785,85,,1428,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672,32,,537.6,percent of total billed charges,32% of total billed charges,672,32,,537.6,percent of total billed charges,32% of total billed charges,1470,70,,1176,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,672,32,,537.6,percent of total billed charges,32% of total billed charges,672,32,,537.6,percent of total billed charges,32% of total billed charges,672,1785,
KNOTLESS T ROPE KIT,6100540,CDM,278,RC,C1769,HCPCS,OUTPATIENT,,,3460.00,1384.00,,,,,,other ,not seperately reimbursable,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,60,,1660.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1384,40,,1107.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,2941,85,,2352.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,2422,70,,1937.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,1107.2,32,,885.76,percent of total billed charges,32% of total billed charges,1107.2,2941,
TUBING SET,6100546,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SAFETOUCH COLLECTION SYSTEM,6100547,CDM,272,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
SAGITTAL BLADE 25,6100551,CDM,272,RC,,,OUTPATIENT,,,174.00,69.60,,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,69.6,40,,55.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,147.9,
BLADE PRECISION,6100552,CDM,272,RC,,,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
BLADE 6118-119-100,6100553,CDM,272,RC,,,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
BLADE 6125-119-090,6100554,CDM,272,RC,,,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
NEEDLE 23G,6100559,CDM,272,RC,,,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
SCORPION NEEDLE,6100562,CDM,272,RC,,,OUTPATIENT,,,590.00,236.00,,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,354,60,,283.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236,40,,188.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,413,70,,330.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,501.5,
GLENOID BASE,6100569,CDM,272,RC,,,OUTPATIENT,,,6100.00,2440.00,,,,,,other ,not seperately reimbursable,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3660,60,,2928,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2440,40,,1952,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,5185,85,,4148,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,4270,70,,3416,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,1952,32,,1561.6,percent of total billed charges,32% of total billed charges,1952,5185,
SUTURE TAK,6100572,CDM,272,RC,,,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
SCREW BIO COMPOSITE,6100573,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1240.00,496.00,,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,744,60,,595.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,496,40,,396.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,1054,85,,843.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,868,70,,694.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,32,,317.44,percent of total billed charges,32% of total billed charges,396.8,1054,
SUTURE J784G,6100574,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
FIBERLOOP4-0,6100575,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DEV-O-LOOPS MINI BLUE,6100595,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
POROUS TITANIUM GLENOID POST,6100598,CDM,272,RC,,,OUTPATIENT,,,34375.00,13750.00,,,,,,other ,not seperately reimbursable,11000,32,,8800,percent of total billed charges,32% of total billed charges,11000,32,,8800,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20625,60,,16500,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13750,40,,11000,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11000,32,,8800,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11000,32,,8800,percent of total billed charges,32% of total billed charges,29218.75,85,,23375,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11000,32,,8800,percent of total billed charges,32% of total billed charges,11000,32,,8800,percent of total billed charges,32% of total billed charges,24062.5,70,,19250,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11000,32,,8800,percent of total billed charges,32% of total billed charges,11000,32,,8800,percent of total billed charges,32% of total billed charges,11000,29218.75,
POLYGRAB DISP TRIPOD,6100600,CDM,272,RC,,,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,80,40,,64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
SUTURE 1893G,6100601,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SUTURE 1716G,6100602,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
SUTURE 8682G,6100603,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SAW BLADE PACK,6100604,CDM,272,RC,,,OUTPATIENT,,,1403.00,561.20,,,,,,other ,not seperately reimbursable,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,841.8,60,,673.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,561.2,40,,448.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,1192.55,85,,954.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,982.1,70,,785.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,448.96,32,,359.17,percent of total billed charges,32% of total billed charges,448.96,1192.55,
SUTURE 687G,6100605,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE X683G,6100606,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SUTURE MX552,6100607,CDM,272,RC,,,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,39.95,
SHOULDER BIO MOD,6100608,CDM,272,RC,,,OUTPATIENT,,,1722.00,688.80,,,,,,other ,not seperately reimbursable,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1033.2,60,,826.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,688.8,40,,551.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,1463.7,85,,1170.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,1205.4,70,,964.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,551.04,32,,440.83,percent of total billed charges,32% of total billed charges,551.04,1463.7,
JOINT IMPLANT S&N TOTAL,6100609,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,15125.00,6050.00,,6050,40,,,percent of total billed charges,40% of total billed charges,4840,32,,3872,percent of total billed charges,32% of total billed charges,4840,32,,3872,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9075,60,,7260,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6050,40,,4840,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4840,32,,3872,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4840,32,,3872,percent of total billed charges,32% of total billed charges,12856.25,85,,10285,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4840,32,,3872,percent of total billed charges,32% of total billed charges,4840,32,,3872,percent of total billed charges,32% of total billed charges,10587.5,70,,8470,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4840,32,,3872,percent of total billed charges,32% of total billed charges,4840,32,,3872,percent of total billed charges,32% of total billed charges,4840,12856.25,
ECTRA PROCEDURE KIT,6100610,CDM,272,RC,,,OUTPATIENT,,,487.00,194.80,,,,,,other ,not seperately reimbursable,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292.2,60,,233.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,194.8,40,,155.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,340.9,70,,272.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,155.84,32,,124.67,percent of total billed charges,32% of total billed charges,155.84,413.95,
PLATE R 22M,6100611,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1636.00,654.40,,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,981.6,60,,785.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,654.4,40,,523.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,1390.6,85,,1112.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,1145.2,70,,916.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,32,,418.82,percent of total billed charges,32% of total billed charges,523.52,1390.6,
SCREW PEEK TENODESIS,6100626,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1513.00,605.20,,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,907.8,60,,726.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,605.2,40,,484.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,1286.05,85,,1028.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,1059.1,70,,847.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,1286.05,
HOOD ORTHO PEEL AWAY,6100631,CDM,272,RC,,,OUTPATIENT,,,128.00,51.20,,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,60,,61.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,51.2,40,,40.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,89.6,70,,71.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,108.8,
COVER CASSETTE,6100632,CDM,272,RC,,,OUTPATIENT,,,206.00,82.40,,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.6,60,,98.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.4,40,,65.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,175.1,
DRAPE BUTTOCKS,6100633,CDM,272,RC,,,OUTPATIENT,,,206.00,82.40,,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.6,60,,98.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.4,40,,65.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,175.1,
LOW PROFILE 8.5MM,6100634,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,767.00,306.80,,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.2,60,,368.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,306.8,40,,245.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,651.95,85,,521.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,536.9,70,,429.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,651.95,
DRILL BIT 2.7,6100635,CDM,272,RC,,,OUTPATIENT,,,217.00,86.80,,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.2,60,,104.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.8,40,,69.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,151.9,70,,121.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,184.45,
EVIVA HANDPIECE 9G,6100637,CDM,272,RC,,,OUTPATIENT,,,649.00,259.60,,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389.4,60,,311.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259.6,40,,207.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,454.3,70,,363.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,551.65,
EVIVA HANDPIECE 9G PETITE,6100639,CDM,272,RC,,,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,260,40,,208,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
EVIVA TRADEMARK,6100640,CDM,272,RC,,,OUTPATIENT,,,194.00,77.60,,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.4,60,,93.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.6,40,,62.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,135.8,70,,108.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,164.9,
BIOPSY SITE INDENTIFIER,6100641,CDM,272,RC,,,OUTPATIENT,,,226.00,90.40,,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.6,60,,108.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,90.4,40,,72.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,192.1,
BIOPSY SITE INDENTIFIER,6100642,CDM,272,RC,,,OUTPATIENT,,,206.00,82.40,,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.6,60,,98.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.4,40,,65.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,175.1,
EVIVA HANDPIECE 9G BLOUNT,6100643,CDM,272,RC,,,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,260,40,,208,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
EVIVA NEEDLE GUIDE 9G,6100644,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
EVIVA NEEDLE GUIDE 12G,6100645,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SUCTION CANISTER W/LID,6100652,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
LF1537,6100661,CDM,272,RC,,,OUTPATIENT,,,1430.00,572.00,,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,858,60,,686.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,572,40,,457.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,1215.5,85,,972.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,1001,70,,800.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,457.6,1215.5,
BRONCH FORCEPS,6100668,CDM,272,RC,,,OUTPATIENT,,,215.00,86.00,,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129,60,,103.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86,40,,68.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,182.75,
O TIP BASKET,6100669,CDM,272,RC,,,OUTPATIENT,,,765.00,306.00,,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459,60,,367.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,306,40,,244.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,650.25,85,,520.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,535.5,70,,428.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,244.8,650.25,
BALLOON 4CM,6100671,CDM,272,RC,,,OUTPATIENT,,,1020.00,408.00,,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,612,60,,489.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408,40,,326.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,867,85,,693.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,714,70,,571.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,867,
PROBE,6100672,CDM,272,RC,,,OUTPATIENT,,,768.00,307.20,,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,60,,368.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,307.2,40,,245.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,537.6,70,,430.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,652.8,
ACCESS SYSTEM CTR03,6100675,CDM,272,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
CANNULA CTS02,6100676,CDM,272,RC,,,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
OPTICAL ACCESS,6100677,CDM,272,RC,,,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,98.6,
COAGULATOR HANDSWITCH,6100678,CDM,272,RC,,,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
SUTURE Y427H,6100679,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
SUTURE J740D,6100680,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
SUTURE J427H,6100681,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SUTURE Z881G,6100682,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SUTURE J947H,6100683,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J260H,6100684,CDM,272,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
SUTURE J864D,6100685,CDM,272,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
VAG PACKING,6100688,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
MINI PLUS KIT,6100689,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
DRESSING MEPILEX 4X12,6100690,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
DRESSING MEPILEX 4X8,6100691,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
DRAPE IOBAN 6651,6100693,CDM,272,RC,,,OUTPATIENT,,,31.10,12.44,,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.66,60,,14.93,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.44,40,,9.95,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,26.44,85,,21.15,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,21.77,70,,17.42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,26.44,
WEBRIL 4,6100694,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRAPE STERI 1018,6100695,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SUPER SUCKER,6100696,CDM,272,RC,,,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74,40,,59.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,157.25,
SCREW DRILLBIT 3.2,6100697,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,503.00,201.20,,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.8,60,,241.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,201.2,40,,160.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,352.1,70,,281.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,160.96,427.55,
SCREW DRILL BIT,6100698,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,576.00,230.40,,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.6,60,,276.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,230.4,40,,184.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,489.6,85,,391.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,403.2,70,,322.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,489.6,
STANDARD TAPER ADAPTOR,6100699,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,880.00,352.00,,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,528,60,,422.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,352,40,,281.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,748,85,,598.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,616,70,,492.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,32,,225.28,percent of total billed charges,32% of total billed charges,281.6,748,
PASSPORT 8X6,6100700,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,147.00,58.80,,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,60,,70.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.8,40,,47.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,102.9,70,,82.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,124.95,
GLENOSPHERE,6100705,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6008.00,2403.20,,2403.2,40,,,percent of total billed charges,40% of total billed charges,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3604.8,60,,2883.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2403.2,40,,1922.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,5106.8,85,,4085.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,4205.6,70,,3364.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,1922.56,32,,1538.05,percent of total billed charges,32% of total billed charges,1922.56,5106.8,
VANGAURD 70MM KNEE,6100713,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,20798.25,8319.30,,8319.3,40,,,percent of total billed charges,40% of total billed charges,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12478.95,60,,9983.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8319.3,40,,6655.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,17678.51,85,,14142.81,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,14558.78,70,,11647.02,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,6655.44,32,,5324.35,percent of total billed charges,32% of total billed charges,6655.44,17678.51,
TOTAL KNEE,6100715,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,15895.00,6358.00,,6358,40,,,percent of total billed charges,40% of total billed charges,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9537,60,,7629.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6358,40,,5086.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,13510.75,85,,10808.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,11126.5,70,,8901.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,5086.4,32,,4069.12,percent of total billed charges,32% of total billed charges,5086.4,13510.75,
KII CANNULA CFS02,6100718,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12,40,,9.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
RETRACTOR C SECTION,6100719,CDM,272,RC,,,OUTPATIENT,,,168.00,67.20,,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,60,,80.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,142.8,
CLIPP APPLIER,6100720,CDM,272,RC,,,OUTPATIENT,,,289.00,115.60,,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.4,60,,138.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,115.6,40,,92.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,245.65,
TROCAR C0Q20,6100721,CDM,272,RC,,,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,79.9,
STRAP SECURE5MM,6100722,CDM,272,RC,,,OUTPATIENT,,,1500.00,600.00,,,,,,other ,not seperately reimbursable,480,32,,384,percent of total billed charges,32% of total billed charges,480,32,,384,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,900,60,,720,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,600,40,,480,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,480,32,,384,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,32,,384,percent of total billed charges,32% of total billed charges,1275,85,,1020,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,32,,384,percent of total billed charges,32% of total billed charges,480,32,,384,percent of total billed charges,32% of total billed charges,1050,70,,840,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,480,32,,384,percent of total billed charges,32% of total billed charges,480,32,,384,percent of total billed charges,32% of total billed charges,480,1275,
ENDO DYE,6100723,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
INTERCEED ABSORBABLE BARRIER,6100724,CDM,272,RC,,,OUTPATIENT,,,805.00,322.00,,,,,,other ,not seperately reimbursable,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,483,60,,386.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,322,40,,257.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,684.25,85,,547.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,563.5,70,,450.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,257.6,32,,206.08,percent of total billed charges,32% of total billed charges,257.6,684.25,
ELECTRODE LOOP,6100725,CDM,272,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
CANNULATED REAMER 6.5,6100726,CDM,272,RC,,,OUTPATIENT,,,592.00,236.80,,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355.2,60,,284.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236.8,40,,189.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,414.4,70,,331.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,503.2,
DRAPE SURGICAL STERI U,6100727,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
CANNULATED DRILL BIT,6100728,CDM,272,RC,,,OUTPATIENT,,,2387.00,954.80,,,,,,other ,not seperately reimbursable,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1432.2,60,,1145.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,954.8,40,,763.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,2028.95,85,,1623.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,1670.9,70,,1336.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,763.84,32,,611.07,percent of total billed charges,32% of total billed charges,763.84,2028.95,
REAMER HEADED,6100740,CDM,272,RC,,,OUTPATIENT,,,768.00,307.20,,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,60,,368.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,307.2,40,,245.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,537.6,70,,430.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,652.8,
ENDOLKIT,6100743,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
RETRIVAL BAG,6100744,CDM,272,RC,,,OUTPATIENT,,,241.00,96.40,,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.6,60,,115.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96.4,40,,77.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,204.85,85,,163.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,168.7,70,,134.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,204.85,
ACHILLES TENDON,6100748,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,9414.00,3765.60,,3765.6,40,,,percent of total billed charges,40% of total billed charges,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5648.4,60,,4518.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3765.6,40,,3012.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,8001.9,85,,6401.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,6589.8,70,,5271.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,3012.48,32,,2409.98,percent of total billed charges,32% of total billed charges,3012.48,8001.9,
K WIRE,6100751,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
OXD ANATOMIC BRG RT LG SIZE 5,6100761,CDM,272,RC,,,OUTPATIENT,,,2800.00,1120.00,,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,32,,716.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1680,60,,1344,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1120,40,,896,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,2380,85,,1904,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,32,,716.8,percent of total billed charges,32% of total billed charges,1960,70,,1568,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,2380,
VANGUARD SPLINED KNEE,6100767,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,4458.00,1783.20,,,,,,other ,not seperately reimbursable,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2674.8,60,,2139.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1783.2,40,,1426.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,3789.3,85,,3031.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,3120.6,70,,2496.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,1426.56,32,,1141.25,percent of total billed charges,32% of total billed charges,1426.56,3789.3,
FLEX UPGRADE,6100768,CDM,278,RC,,,OUTPATIENT,,,3314.00,1325.60,,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1988.4,60,,1590.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1325.6,40,,1060.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,2816.9,85,,2253.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,2319.8,70,,1855.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,2816.9,
SUTURE TAK,6100771,CDM,272,RC,,,OUTPATIENT,,,1513.00,605.20,,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,907.8,60,,726.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,605.2,40,,484.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,1286.05,85,,1028.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,1059.1,70,,847.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,32,,387.33,percent of total billed charges,32% of total billed charges,484.16,1286.05,
CANNULA 5.5,6100773,CDM,272,RC,,,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
BARD GUIDEWIRE 20FR,6100774,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,660.00,264.00,,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,60,,316.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,264,40,,211.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,561,85,,448.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,462,70,,369.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,561,
BB-TAK THREADED,6100775,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,336.00,134.40,,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,60,,161.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,134.4,40,,107.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,235.2,70,,188.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,285.6,
IMPLANT SYSTEM WITH NEEDLE SCORPION,6100776,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3500.00,1400.00,,,,,,other ,not seperately reimbursable,1120,32,,896,percent of total billed charges,32% of total billed charges,1120,32,,896,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2100,60,,1680,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1400,40,,1120,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1120,32,,896,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1120,32,,896,percent of total billed charges,32% of total billed charges,2975,85,,2380,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1120,32,,896,percent of total billed charges,32% of total billed charges,1120,32,,896,percent of total billed charges,32% of total billed charges,2450,70,,1960,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1120,32,,896,percent of total billed charges,32% of total billed charges,1120,32,,896,percent of total billed charges,32% of total billed charges,1120,2975,
PLANTAR 1ST PLATE,6100777,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,5874.00,2349.60,,2349.6,40,,,percent of total billed charges,40% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3524.4,60,,2819.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2349.6,40,,1879.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,4992.9,85,,3994.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,4992.9,
IMPLANT SYSTEM,6100778,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2420.00,968.00,,,,,,other ,not seperately reimbursable,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1452,60,,1161.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,968,40,,774.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,2057,85,,1645.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,1694,70,,1355.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,774.4,32,,619.52,percent of total billed charges,32% of total billed charges,774.4,2057,
FOOT STRAP ANKLE,6100780,CDM,272,RC,,,OUTPATIENT,,,148.00,59.20,,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,60,,71.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,59.2,40,,47.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,103.6,70,,82.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,125.8,
INCISOR BLADE 3.5,6100781,CDM,272,RC,,,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
MICRO QUICK 2/0,6100784,CDM,272,RC,,,OUTPATIENT,,,1029.00,411.60,,,,,,other ,not seperately reimbursable,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,617.4,60,,493.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,411.6,40,,329.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,874.65,85,,699.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,720.3,70,,576.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,329.28,32,,263.42,percent of total billed charges,32% of total billed charges,329.28,874.65,
PLATE COMPOSITE,6100785,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,592.00,236.80,,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355.2,60,,284.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236.8,40,,189.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,414.4,70,,331.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,503.2,
SCREW CORTICAL,6100786,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,198.00,79.20,,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.8,60,,95.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.2,40,,63.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,168.3,
SCREW CORTICAL LOCKING,6100787,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,633.00,253.20,,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.8,60,,303.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,253.2,40,,202.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,538.05,85,,430.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,443.1,70,,354.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,538.05,
ZIPTIGHT,6100788,CDM,272,RC,,,OUTPATIENT,,,2621.00,1048.40,,,,,,other ,not seperately reimbursable,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1572.6,60,,1258.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1048.4,40,,838.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,2227.85,85,,1782.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,1834.7,70,,1467.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,838.72,32,,670.98,percent of total billed charges,32% of total billed charges,838.72,2227.85,
DRILL BIT 2.5MM,6100789,CDM,272,RC,,,OUTPATIENT,,,468.00,187.20,,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280.8,60,,224.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,187.2,40,,149.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,397.8,85,,318.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,327.6,70,,262.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,397.8,
SCREW CORC,6100790,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,220.00,88.00,,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,88,40,,70.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,187,
DRILL BIT,6100791,CDM,272,RC,,,OUTPATIENT,,,814.00,325.60,,,,,,other ,not seperately reimbursable,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.4,60,,390.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,325.6,40,,260.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,691.9,85,,553.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,569.8,70,,455.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,260.48,32,,208.38,percent of total billed charges,32% of total billed charges,260.48,691.9,
DRILL BIT 2.5MM,6100792,CDM,272,RC,,,OUTPATIENT,,,495.00,198.00,,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297,60,,237.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,346.5,70,,277.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,420.75,
SCREW CORTICAL,6100793,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.6,40,,66.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
SCREW,6100795,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2613.00,1045.20,,,,,,other ,not seperately reimbursable,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1567.8,60,,1254.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1045.2,40,,836.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,2221.05,85,,1776.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,1829.1,70,,1463.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,836.16,32,,668.93,percent of total billed charges,32% of total billed charges,836.16,2221.05,
SCREW CORTICAL,6100796,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
SCREW CORTICAL,6100797,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,220.00,88.00,,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,88,40,,70.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,187,
SCREW CORTICAL,6100798,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.6,40,,66.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
SCREW CORTICAL LOCKING,6100799,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1196.00,478.40,,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,717.6,60,,574.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,478.4,40,,382.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,1016.6,85,,813.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,837.2,70,,669.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,1016.6,
BLADE MEDIUM 8.5X7,6100801,CDM,272,RC,,,OUTPATIENT,,,179.00,71.60,,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.4,60,,85.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,152.15,
K WIRE .45,6100806,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
K WIRE .54,6100807,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
PLATE LOCKING 4 HOLE,6100808,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3702.00,1480.80,,,,,,other ,not seperately reimbursable,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2221.2,60,,1776.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1480.8,40,,1184.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,3146.7,85,,2517.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,2591.4,70,,2073.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,1184.64,32,,947.71,percent of total billed charges,32% of total billed charges,1184.64,3146.7,
SCREW CORTICAL,6100809,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.6,40,,66.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
SCREW CORTICAL,6100810,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.2,40,,96.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,257.55,
SCREW CORTICAL,6100814,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.6,40,,66.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
SCREW CENTRAL,6100816,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,558.00,223.20,,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,223.2,40,,178.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,474.3,
TRAY W/LOCKING RING,6100817,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6641.00,2656.40,,2656.4,40,,,percent of total billed charges,40% of total billed charges,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3984.6,60,,3187.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2656.4,40,,2125.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,5644.85,85,,4515.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,4648.7,70,,3718.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,2125.12,32,,1700.1,percent of total billed charges,32% of total billed charges,2125.12,5644.85,
SCREW FIXED LOCKING,6100818,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,484.00,193.60,,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,193.6,40,,154.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,411.4,
SCREW FIXED LOCKING,6100819,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,484.00,193.60,,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,193.6,40,,154.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,411.4,
MINI HUMERAL STEIN,6100820,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,12650.00,5060.00,,5060,40,,,percent of total billed charges,40% of total billed charges,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7590,60,,6072,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5060,40,,4048,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,10752.5,85,,8602,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,8855,70,,7084,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,4048,32,,3238.4,percent of total billed charges,32% of total billed charges,4048,10752.5,
SCREW FIXED LOCKING,6100821,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,484.00,193.60,,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,193.6,40,,154.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,411.4,
SCREW FIXED LOCKING,6100822,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,454.00,181.60,,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.4,60,,217.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,181.6,40,,145.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,317.8,70,,254.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,385.9,
QUICK CONNECT DRILL BIT,6100823,CDM,272,RC,,,OUTPATIENT,,,292.00,116.80,,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.2,60,,140.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,116.8,40,,93.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,204.4,70,,163.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,93.44,248.2,
SHELL  ACETABULAR,6100824,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,3828.00,1531.20,,,,,,other ,not seperately reimbursable,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2296.8,60,,1837.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1531.2,40,,1224.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,3253.8,85,,2603.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,2679.6,70,,2143.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,1224.96,32,,979.97,percent of total billed charges,32% of total billed charges,1224.96,3253.8,
PLUG APICAL HOLE,6100825,CDM,272,RC,,,OUTPATIENT,,,520.00,208.00,,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,60,,249.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,208,40,,166.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,364,70,,291.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,166.4,442,
LINER ACET,6100826,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6281.00,2512.40,,2512.4,40,,,percent of total billed charges,40% of total billed charges,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3768.6,60,,3014.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2512.4,40,,2009.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,5338.85,85,,4271.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,4396.7,70,,3517.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,2009.92,32,,1607.94,percent of total billed charges,32% of total billed charges,2009.92,5338.85,
HIP W/OXI,6100829,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,15130.00,6052.00,,6052,40,,,percent of total billed charges,40% of total billed charges,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9078,60,,7262.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6052,40,,4841.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,12860.5,85,,10288.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,10591,70,,8472.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,4841.6,32,,3873.28,percent of total billed charges,32% of total billed charges,4841.6,12860.5,
SCREW CANNULATED,6100830,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1183.00,473.20,,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,709.8,60,,567.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,473.2,40,,378.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,1005.55,85,,804.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,828.1,70,,662.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,1005.55,
K WIRE,6100831,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,413.00,165.20,,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.8,60,,198.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,351.05,85,,280.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,289.1,70,,231.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,351.05,
SCREW 4.0,6100835,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,399.00,159.60,,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.4,60,,191.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,159.6,40,,127.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,279.3,70,,223.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,339.15,
SCREW 4.0,6100837,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.6,40,,66.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
SCREW 4.0,6100838,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,187.00,74.80,,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.2,60,,89.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.8,40,,59.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,130.9,70,,104.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,158.95,
DRILL,6100848,CDM,272,RC,,,OUTPATIENT,,,1582.00,632.80,,,,,,other ,not seperately reimbursable,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,949.2,60,,759.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,632.8,40,,506.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,506.24,32,,404.99,percent of total billed charges,32% of total billed charges,506.24,1344.7,
SCREW CORTEX SELF,6100851,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW SHAFT 3.5 18MM  204.218,6100852,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW SHAFT 3.5 20MM  204.220,6100853,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW SHAFT 3.5 22MM  204.222,6100854,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW LOCKING,6100855,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,255,
SCREW SHAFT 3.5 26MM  204.226,6100856,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW  NONLOCKING,6100857,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,248.00,99.20,,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,60,,119.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,99.2,40,,79.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,210.8,85,,168.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,173.6,70,,138.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,210.8,
SCREW SHAFT 3.5 30MM  204.230,6100858,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW SHAFT 3.5 32MM  204.232,6100859,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW SHAFT 3.5 34MM  204.234,6100860,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW SHAFT 3.5 36MM  204.236,6100861,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW SHAFT 3.5 38MM  204.238,6100862,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
SCREW CORTEX,6100863,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,102.00,40.80,,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,60,,48.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40.8,40,,32.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,86.7,
SCREW,6100864,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1375.00,550.00,,,,,,other ,not seperately reimbursable,440,32,,352,percent of total billed charges,32% of total billed charges,440,32,,352,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,825,60,,660,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,550,40,,440,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,440,32,,352,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440,32,,352,percent of total billed charges,32% of total billed charges,1168.75,85,,935,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440,32,,352,percent of total billed charges,32% of total billed charges,440,32,,352,percent of total billed charges,32% of total billed charges,962.5,70,,770,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,440,32,,352,percent of total billed charges,32% of total billed charges,440,32,,352,percent of total billed charges,32% of total billed charges,440,1168.75,
SCREW CORTEX 3.5 18MM   204.818,6100865,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
SCREW CORTEX 3.5 20MM   204.820,6100866,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
SCREW LOCKING,6100867,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,707.00,282.80,,,,,,other ,not seperately reimbursable,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424.2,60,,339.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,282.8,40,,226.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,600.95,85,,480.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,494.9,70,,395.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,226.24,32,,180.99,percent of total billed charges,32% of total billed charges,226.24,600.95,
SCREW CORTEX 3.5 24MM   204.824,6100868,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 26MM   204.826,6100869,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 28MM   204.828,6100870,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 30MM   204.830,6100871,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 32MM   204.832,6100872,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 34MM   204.834,6100873,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 36MM   204.836,6100874,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 38MM   204.838,6100875,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 40MM   204.840,6100876,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW CORTEX 3.5 45MM   204.845,6100877,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
SCREW CORTEX 3.5 50MM   204.850,6100878,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
SCREW BONE CANC THED 4.0 10MM  206.010,6100879,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 12MM  206.012,6100880,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
SCREW BONE CANC THED 4.0 14MM  206.014,6100881,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
SCREW BONE CANC THED 4.0 16MM  206.016,6100882,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26,40,,20.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,55.25,
SCREW BONE CANC THED 4.0 18MM  206.018,6100883,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26,40,,20.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,55.25,
SCREW BONE CANC THED 4.0 20MM  206.020,6100884,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 22MM  206.022,6100885,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
SCREW BONE CANC THED 4.0 24MM  206.024,6100886,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 26MM  206.026,6100887,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 28MM  206.028,6100888,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 30MM  206.030,6100889,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 35MM  206.035,6100890,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
MENISCAL ROOT KIT,6100891,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3911.00,1564.40,,,,,,other ,not seperately reimbursable,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2346.6,60,,1877.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1564.4,40,,1251.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,3324.35,85,,2659.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,2737.7,70,,2190.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,1251.52,32,,1001.22,percent of total billed charges,32% of total billed charges,1251.52,3324.35,
SCREW BONE CANC THED 4.0 45MM  206.045,6100892,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 50MM  206.050,6100893,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 55MM  206.055,6100894,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC THED 4.0 60MM  206.060,6100895,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
PASSPORT 10X40,6100896,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
PASSPORT 8X6,6100897,CDM,278,RC,,,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
SCREW BONE CANC PTHED 4.0 14MM  207.014,6100898,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW,6100899,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,666.00,266.40,,,,,,other ,not seperately reimbursable,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,399.6,60,,319.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,266.4,40,,213.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,566.1,85,,452.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,466.2,70,,372.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,213.12,32,,170.5,percent of total billed charges,32% of total billed charges,213.12,566.1,
PASSPORT 10X50,6100900,CDM,278,RC,,,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,82.45,
TIGERLINK,6100901,CDM,278,RC,,,OUTPATIENT,,,391.00,156.40,,,,,,other ,not seperately reimbursable,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.6,60,,187.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.4,40,,125.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,332.35,85,,265.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,273.7,70,,218.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,125.12,32,,100.1,percent of total billed charges,32% of total billed charges,125.12,332.35,
SUTURE TAPE REPAIR NEEDLES,6100902,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,454.00,181.60,,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.4,60,,217.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,181.6,40,,145.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,317.8,70,,254.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,385.9,
SCREW BONE CANC PTHED 4.0 24MM  207.024,6100903,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC PTHED 4.0 26MM  207.026,6100904,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
SCREW BONE CANC PTHED 4.0 28MM  207.028,6100905,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC PTHED 4.0 30MM  207.030,6100906,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
SCREW CANNULATED,6100907,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,564.00,225.60,,,,,,other ,not seperately reimbursable,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,338.4,60,,270.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,225.6,40,,180.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,479.4,85,,383.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,394.8,70,,315.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,180.48,32,,144.38,percent of total billed charges,32% of total billed charges,180.48,479.4,
SCREW BONE CANC PTHED 4.0 40MM  207.040,6100908,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SCREW BONE CANC PTHED 4.0 45MM  207.045,6100909,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16,40,,12.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
SCREW BONE CANC PTHED 4.0 50MM  207.050,6100910,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
PLATE LCD,6100911,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,572.00,228.80,,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,343.2,60,,274.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.8,40,,183.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,486.2,85,,388.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,400.4,70,,320.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,486.2,
PLATE LOCKING,6100912,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3152.00,1260.80,,,,,,other ,not seperately reimbursable,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1891.2,60,,1512.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1260.8,40,,1008.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,2679.2,85,,2143.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,1008.64,32,,806.91,percent of total billed charges,32% of total billed charges,1008.64,2679.2,
PLATE LC-DCP 3.5 8 HOLES 103MM 223.58,6100913,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,208.00,83.20,,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,60,,99.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.2,40,,66.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,145.6,70,,116.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,176.8,
PLATE LC-DCP 3.5 9 HOLES 116MM 223.59,6100914,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,217.00,86.80,,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.2,60,,104.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.8,40,,69.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,151.9,70,,121.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,184.45,
LOCK DISTAL FIBULA PLT,6100915,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2555.00,1022.00,,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1533,60,,1226.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1022,40,,817.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,2171.75,85,,1737.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,1788.5,70,,1430.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,817.6,2171.75,
PLATE T SM 3HO/H 3HO/S 50MM RT 241.13,6100916,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,163.00,65.20,,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,60,,78.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.2,40,,52.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,114.1,70,,91.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,138.55,
PLATE T SM 3HO/H 5HO/S 67MM RT 241.15,6100917,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,186.00,74.40,,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.6,60,,89.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,130.2,70,,104.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,158.1,
PLATE BASEPLATE,6100918,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,8800.00,3520.00,,3520,40,,,percent of total billed charges,40% of total billed charges,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,60,,4224,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3520,40,,2816,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,7480,85,,5984,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,6160,70,,4928,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,2816,32,,2252.8,percent of total billed charges,32% of total billed charges,2816,7480,
PLATE T SM 3HO/H 4HO/S 63MM OB 241.24,6100919,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,297.00,118.80,,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,252.45,
PLATE T SM 3HO/H 5HO/S 75MM OB 241.25,6100920,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,308.00,123.20,,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,60,,147.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.2,40,,98.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,261.8,
PLATE 5 HOLE,6100921,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2750.00,1100.00,,,,,,other ,not seperately reimbursable,880,32,,704,percent of total billed charges,32% of total billed charges,880,32,,704,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1650,60,,1320,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1100,40,,880,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,880,32,,704,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,880,32,,704,percent of total billed charges,32% of total billed charges,2337.5,85,,1870,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,880,32,,704,percent of total billed charges,32% of total billed charges,880,32,,704,percent of total billed charges,32% of total billed charges,1925,70,,1540,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,880,32,,704,percent of total billed charges,32% of total billed charges,880,32,,704,percent of total billed charges,32% of total billed charges,880,2337.5,
PLATE 1/3TUBE W/COLLAR 3H/37MM  241.33,6100922,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
SUTURE CUP UNIVERSAL,6100923,CDM,278,RC,,,OUTPATIENT,,,4900.00,1960.00,,,,,,other ,not seperately reimbursable,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2940,60,,2352,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1960,40,,1568,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,4165,85,,3332,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,3430,70,,2744,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,1568,32,,1254.4,percent of total billed charges,32% of total billed charges,1568,4165,
PLATE 1/3TUBE W/COLLAR 8H/97MM  241.38,6100926,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,139.00,55.60,,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.4,60,,66.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.6,40,,44.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,97.3,70,,77.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,118.15,
PLATE,6100927,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3768.00,1507.20,,,,,,other ,not seperately reimbursable,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2260.8,60,,1808.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1507.2,40,,1205.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,3202.8,85,,2562.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,1205.76,32,,964.61,percent of total billed charges,32% of total billed charges,1205.76,3202.8,
PLATE CLOVERLEAF THN/BLDE 3H/88MM 241.83,6100928,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,396.00,158.40,,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.6,60,,190.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.4,40,,126.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,277.2,70,,221.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,336.6,
PLATE CLOVERLEF THN/BLDE 4H/104MM 241.83,6100929,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,424.00,169.60,,,,,,other ,not seperately reimbursable,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,60,,203.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,169.6,40,,135.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,296.8,70,,237.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,135.68,32,,108.54,percent of total billed charges,32% of total billed charges,135.68,360.4,
WIRE,6100930,CDM,272,RC,,,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74,40,,59.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,157.25,
KWIRE,6100931,CDM,272,RC,,,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.4,40,,35.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
K WIRE,6100932,CDM,272,RC,,,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.4,40,,35.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
PLATE SEMI/TUBE 4H/71MM 222.04,6100933,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.6,40,,26.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
PLATE SEMI/TUBE 7H/119MM 222.07,6100936,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
PLATE T 6HOLES/116MM  240.16,6100956,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,388.00,155.20,,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,232.8,60,,186.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,271.6,70,,217.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,124.16,329.8,
PLATE T 8HOLES/148MM  240.18,6100957,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,545.00,218.00,,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327,60,,261.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,218,40,,174.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,463.25,85,,370.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,381.5,70,,305.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,463.25,
SCREW CORTEX 4.5 14MM  214.814,6100982,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
SCREW CORTEX 4.5 16MM  214.816,6100983,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
SCREW CORTEX 4.5 20MM  214.820,6100985,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
SCREW CAN 8.0,6100987,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1163.00,465.20,,,,,,other ,not seperately reimbursable,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,697.8,60,,558.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,465.2,40,,372.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,988.55,85,,790.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,814.1,70,,651.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,372.16,32,,297.73,percent of total billed charges,32% of total billed charges,372.16,988.55,
SCREW MALLEOLAR 4.5/70MM 215.070,6101020,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
SCREW CANCELLOUS 6.5 THRD 40MM  218.040,6101054,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
WASHER 13.0MM   219.99,6101055,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
RP INSERT 5-17.5MM,6101056,CDM,272,RC,,,OUTPATIENT,,,7123.00,2849.20,,,,,,other ,not seperately reimbursable,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4273.8,60,,3419.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2849.2,40,,2279.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,6054.55,85,,4843.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,4986.1,70,,3988.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,2279.36,32,,1823.49,percent of total billed charges,32% of total billed charges,2279.36,6054.55,
WASHER 7.0MM   219.98,6101058,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
ENDO 55 RELOAD   TVR55,6101060,CDM,272,RC,,,OUTPATIENT,,,197.00,78.80,,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.2,60,,94.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,137.9,70,,110.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,167.45,
ARTHO IRRIG SET,6101062,CDM,272,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
DRILL,6101063,CDM,272,RC,,,OUTPATIENT,,,506.00,202.40,,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303.6,60,,242.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,202.4,40,,161.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,354.2,70,,283.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,430.1,
DRIVER,6101064,CDM,272,RC,,,OUTPATIENT,,,262.00,104.80,,,,,,other ,not seperately reimbursable,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.2,60,,125.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,104.8,40,,83.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,183.4,70,,146.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,83.84,32,,67.07,percent of total billed charges,32% of total billed charges,83.84,222.7,
DRIVER,6101065,CDM,272,RC,,,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.2,40,,96.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,257.55,
REAMER HEADED,6101067,CDM,272,RC,,,OUTPATIENT,,,592.00,236.80,,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355.2,60,,284.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236.8,40,,189.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,414.4,70,,331.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,503.2,
DRILL BIT,6101071,CDM,272,RC,,,OUTPATIENT,,,537.00,214.80,,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,322.2,60,,257.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,214.8,40,,171.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,375.9,70,,300.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,456.45,
SCREW LOCKING 1.5,6101073,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.2,40,,96.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,257.55,
SCREW LOCKING,6101074,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
SCREW LOCKING 1.5,6101075,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,523.00,209.20,,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.8,60,,251.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.2,40,,167.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,366.1,70,,292.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,167.36,444.55,
SCREW LOCKING,6101076,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,495.00,198.00,,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297,60,,237.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,346.5,70,,277.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,420.75,
SCREW NONLOCKING 1.5,6101077,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,231.00,92.40,,,,,,other ,not seperately reimbursable,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,60,,110.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,92.4,40,,73.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,161.7,70,,129.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,73.92,32,,59.14,percent of total billed charges,32% of total billed charges,73.92,196.35,
PUNCH DISP 4.5,6101078,CDM,272,RC,,,OUTPATIENT,,,297.00,118.80,,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,252.45,
ACU LOCK VDR PLT STD,6101082,CDM,272,RC,,,OUTPATIENT,,,2792.00,1116.80,,,,,,other ,not seperately reimbursable,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1675.2,60,,1340.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1116.8,40,,893.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,2373.2,85,,1898.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,1954.4,70,,1563.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,893.44,32,,714.75,percent of total billed charges,32% of total billed charges,893.44,2373.2,
KNEE FEMORAL CEMENT,6101083,CDM,278,RC,,,OUTPATIENT,,,7520.00,3008.00,,3008,40,,,percent of total billed charges,40% of total billed charges,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4512,60,,3609.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3008,40,,2406.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,6392,85,,5113.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,5264,70,,4211.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,2406.4,32,,1925.12,percent of total billed charges,32% of total billed charges,2406.4,6392,
BAR LOCKING,6101084,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,548.00,219.20,,,,,,other ,not seperately reimbursable,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328.8,60,,263.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,219.2,40,,175.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,465.8,85,,372.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,383.6,70,,306.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,175.36,32,,140.29,percent of total billed charges,32% of total billed charges,175.36,465.8,
MINI BASEPLATE,6101085,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6325.00,2530.00,,2530,40,,,percent of total billed charges,40% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3795,60,,3036,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2530,40,,2024,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,5376.25,85,,4301,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,4427.5,70,,3542,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,5376.25,
PIN REVERSE SHOULDER,6101086,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,452.00,180.80,,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.2,60,,216.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,180.8,40,,144.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,384.2,85,,307.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,316.4,70,,253.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,144.64,384.2,
VOLAR PLATE,6101087,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1911.00,764.40,,,,,,other ,not seperately reimbursable,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1146.6,60,,917.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,764.4,40,,611.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,1624.35,85,,1299.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,1337.7,70,,1070.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,611.52,32,,489.22,percent of total billed charges,32% of total billed charges,611.52,1624.35,
MICRO INTRO KIT 5FR,6101089,CDM,272,RC,,,OUTPATIENT,,,82.23,32.89,,,,,,other ,not seperately reimbursable,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.34,60,,39.47,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.89,40,,26.31,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,69.9,85,,55.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,57.56,70,,46.05,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,26.31,32,,21.05,percent of total billed charges,32% of total billed charges,26.31,69.9,
BALL ELECTRODE,6101091,CDM,272,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
DRAPE STERI 1050,6101092,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
TRAY BIOMET STEMMED,6101094,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,7183.00,2873.20,,2873.2,40,,,percent of total billed charges,40% of total billed charges,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4309.8,60,,3447.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2873.2,40,,2298.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,6105.55,85,,4884.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,5028.1,70,,4022.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,2298.56,32,,1838.85,percent of total billed charges,32% of total billed charges,2298.56,6105.55,
SHOULDER SYSTEM,6101098,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,8360.00,3344.00,,3344,40,,,percent of total billed charges,40% of total billed charges,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5016,60,,4012.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3344,40,,2675.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,7106,85,,5684.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,5852,70,,4681.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,2675.2,32,,2140.16,percent of total billed charges,32% of total billed charges,2675.2,7106,
DRILL BIT,6101101,CDM,272,RC,,,OUTPATIENT,,,811.00,324.40,,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.6,60,,389.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,689.35,85,,551.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,567.7,70,,454.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,689.35,
DRILL BIT,6101102,CDM,272,RC,,,OUTPATIENT,,,495.00,198.00,,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297,60,,237.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,420.75,85,,336.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,346.5,70,,277.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,32,,126.72,percent of total billed charges,32% of total billed charges,158.4,420.75,
OPTIVAC KIT,6101103,CDM,272,RC,,,OUTPATIENT,,,358.00,143.20,,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.8,60,,171.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.2,40,,114.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,250.6,70,,200.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,32,,91.65,percent of total billed charges,32% of total billed charges,114.56,304.3,
K WIRE TK-035-9S,6101104,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
K WIRE TK-045-9S,6101105,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
FEMUR HEAD,6101107,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,12191.00,4876.40,,4876.4,40,,,percent of total billed charges,40% of total billed charges,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7314.6,60,,5851.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4876.4,40,,3901.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,10362.35,85,,8289.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,8533.7,70,,6826.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,3901.12,32,,3120.9,percent of total billed charges,32% of total billed charges,3901.12,10362.35,
SCREW 4.0 CANNULATED,6101108,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,608.00,243.20,,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364.8,60,,291.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.2,40,,194.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,516.8,85,,413.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,425.6,70,,340.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,516.8,
SCREW 4.0 CANNULATED,6101109,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,260,40,,208,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
FASTIN RC W/ORTHOCORD,6101110,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,971.00,388.40,,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,582.6,60,,466.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,388.4,40,,310.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,825.35,85,,660.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,679.7,70,,543.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,825.35,
OXFORD PARTIAL KNEE SYSTEM,6101111,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,14273.00,5709.20,,5709.2,40,,,percent of total billed charges,40% of total billed charges,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8563.8,60,,6851.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5709.2,40,,4567.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,12132.05,85,,9705.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,9991.1,70,,7992.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,4567.36,32,,3653.89,percent of total billed charges,32% of total billed charges,4567.36,12132.05,
OXFORD  KNEE SYSTEM,6101113,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,13000.00,5200.00,,5200,40,,,percent of total billed charges,40% of total billed charges,4160,32,,3328,percent of total billed charges,32% of total billed charges,4160,32,,3328,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7800,60,,6240,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5200,40,,4160,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4160,32,,3328,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4160,32,,3328,percent of total billed charges,32% of total billed charges,11050,85,,8840,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4160,32,,3328,percent of total billed charges,32% of total billed charges,4160,32,,3328,percent of total billed charges,32% of total billed charges,9100,70,,7280,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4160,32,,3328,percent of total billed charges,32% of total billed charges,4160,32,,3328,percent of total billed charges,32% of total billed charges,4160,11050,
KNEE TIBAL CEMENT,6101114,CDM,272,RC,,,OUTPATIENT,,,3600.00,1440.00,,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,32,,921.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,60,,1728,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1440,40,,1152,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,32,,921.6,percent of total billed charges,32% of total billed charges,2520,70,,2016,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,32,,921.6,percent of total billed charges,32% of total billed charges,1152,3060,
TAPERLOC COMPLETE PRIMARY,6101115,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,16828.00,6731.20,,6731.2,40,,,percent of total billed charges,40% of total billed charges,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10096.8,60,,8077.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6731.2,40,,5384.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,14303.8,85,,11443.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,11779.6,70,,9423.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,5384.96,32,,4307.97,percent of total billed charges,32% of total billed charges,5384.96,14303.8,
QUICKPASS CRESENT,6101118,CDM,272,RC,,,OUTPATIENT,,,630.00,252.00,,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,60,,302.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252,40,,201.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,441,70,,352.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,535.5,
QUICKPASS 90,6101119,CDM,272,RC,,,OUTPATIENT,,,630.00,252.00,,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,60,,302.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252,40,,201.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,441,70,,352.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,32,,161.28,percent of total billed charges,32% of total billed charges,201.6,535.5,
PLATE DVR SHORT LEFT,6101124,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2753.00,1101.20,,,,,,other ,not seperately reimbursable,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1651.8,60,,1321.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1101.2,40,,880.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,2340.05,85,,1872.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,1927.1,70,,1541.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,880.96,32,,704.77,percent of total billed charges,32% of total billed charges,880.96,2340.05,
KWIRE,6101125,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
PEG DRIVER,6101126,CDM,272,RC,,,OUTPATIENT,,,151.00,60.40,,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.6,60,,72.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,60.4,40,,48.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,105.7,70,,84.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,128.35,
DRIVER FAST 2.0,6101127,CDM,272,RC,,,OUTPATIENT,,,369.00,147.60,,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.4,60,,177.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,147.6,40,,118.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,313.65,
DRIVER FAST 2.5,6101128,CDM,272,RC,,,OUTPATIENT,,,369.00,147.60,,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.4,60,,177.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,147.6,40,,118.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,258.3,70,,206.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,32,,94.46,percent of total billed charges,32% of total billed charges,118.08,313.65,
SCREW NONLOCKING 10MM,6101130,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,297.00,118.80,,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,252.45,
SCREW NONLOCKING 12MM,6101131,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,322.00,128.80,,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.2,60,,154.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,128.8,40,,103.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,273.7,
PEG THREADED,6101132,CDM,272,RC,,,OUTPATIENT,,,297.00,118.80,,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,252.45,
PEG THREADED,6101133,CDM,272,RC,,,OUTPATIENT,,,297.00,118.80,,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,252.45,
COMP REVERSE SHOULDER,6101134,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6089.00,2435.60,,2435.6,40,,,percent of total billed charges,40% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3653.4,60,,2922.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2435.6,40,,1948.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,5175.65,85,,4140.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,4262.3,70,,3409.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,32,,1558.78,percent of total billed charges,32% of total billed charges,1948.48,5175.65,
STRAP ANKLE,6101135,CDM,272,RC,,,OUTPATIENT,,,178.00,71.20,,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.8,60,,85.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,71.2,40,,56.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,151.3,85,,121.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,124.6,70,,99.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,151.3,
PLATE RIGHT,6101136,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3143.00,1257.20,,,,,,other ,not seperately reimbursable,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1885.8,60,,1508.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1257.2,40,,1005.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,2671.55,85,,2137.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,2200.1,70,,1760.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,1005.76,32,,804.61,percent of total billed charges,32% of total billed charges,1005.76,2671.55,
PLATE ACP,6101137,CDM,272,RC,,,OUTPATIENT,,,935.00,374.00,,,,,,other ,not seperately reimbursable,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,561,60,,448.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,374,40,,299.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,794.75,85,,635.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,654.5,70,,523.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,299.2,32,,239.36,percent of total billed charges,32% of total billed charges,299.2,794.75,
MENISCAL CINCH,6101138,CDM,272,RC,,,OUTPATIENT,,,1122.00,448.80,,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,673.2,60,,538.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,448.8,40,,359.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,953.7,85,,762.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,785.4,70,,628.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,953.7,
SUTURE TAPE,6101139,CDM,272,RC,,,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
SCREW LOCKING,6101140,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,330.00,132.00,,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,60,,158.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,231,70,,184.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,280.5,
SWIFT STITCH,6101141,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,943.00,377.20,,,,,,other ,not seperately reimbursable,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.8,60,,452.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.2,40,,301.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,801.55,85,,641.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,660.1,70,,528.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,301.76,32,,241.41,percent of total billed charges,32% of total billed charges,301.76,801.55,
WASHER,6101145,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.2,40,,96.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,257.55,
PLATE SMALL,6101146,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3905.00,1562.00,,,,,,other ,not seperately reimbursable,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2343,60,,1874.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1562,40,,1249.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,3319.25,85,,2655.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,2733.5,70,,2186.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,1249.6,32,,999.68,percent of total billed charges,32% of total billed charges,1249.6,3319.25,
REAMING ROD,6101147,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,633.00,253.20,,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.8,60,,303.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,253.2,40,,202.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,538.05,85,,430.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,443.1,70,,354.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,538.05,
CANNULATED TIBAL NAIL,6101148,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,7800.00,3120.00,,3120,40,,,percent of total billed charges,40% of total billed charges,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4680,60,,3744,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3120,40,,2496,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,6630,85,,5304,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,5460,70,,4368,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,2496,32,,1996.8,percent of total billed charges,32% of total billed charges,2496,6630,
SCREW 18MM 3.5,6101149,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,460.00,184.00,,,,,,other ,not seperately reimbursable,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,276,60,,220.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,184,40,,147.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,322,70,,257.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,147.2,32,,117.76,percent of total billed charges,32% of total billed charges,147.2,391,
SCREW 28MM 3.5,6101151,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,443.00,177.20,,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.8,60,,212.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.2,40,,141.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,376.55,85,,301.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,310.1,70,,248.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,376.55,
GUIDE WIRE,6101152,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
GRAFTBOLT,6101153,CDM,272,RC,,,OUTPATIENT,,,1554.00,621.60,,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.4,60,,745.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,621.6,40,,497.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,1087.8,70,,870.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,1320.9,
PLATE TUBULES 7.0,6101154,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,886.00,354.40,,,,,,other ,not seperately reimbursable,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,531.6,60,,425.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,354.4,40,,283.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,753.1,85,,602.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,620.2,70,,496.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,283.52,32,,226.82,percent of total billed charges,32% of total billed charges,283.52,753.1,
CANCELLOUS 4-10MM 5CC,6101155,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,482.00,192.80,,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.2,60,,231.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,192.8,40,,154.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,409.7,85,,327.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,337.4,70,,269.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,409.7,
CANCELLOUS 1-4MM 30CC,6101158,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1262.00,504.80,,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,757.2,60,,605.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,504.8,40,,403.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,1072.7,85,,858.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,883.4,70,,706.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,403.84,1072.7,
SCREW CORTICAL,6101159,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
SHAVER 2.0,6101160,CDM,272,RC,,,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
POWER RASP,6101161,CDM,272,RC,,,OUTPATIENT,,,399.00,159.60,,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.4,60,,191.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,159.6,40,,127.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,279.3,70,,223.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,339.15,
TIGHTROPE ACL,6101162,CDM,272,RC,,,OUTPATIENT,,,2950.00,1180.00,,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,32,,755.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1770,60,,1416,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1180,40,,944,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,2507.5,85,,2006,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,32,,755.2,percent of total billed charges,32% of total billed charges,2065,70,,1652,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,2507.5,
DRILLS,6101163,CDM,272,RC,,,OUTPATIENT,,,1128.00,451.20,,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676.8,60,,541.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,451.2,40,,360.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,958.8,85,,767.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,789.6,70,,631.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,958.8,
VANGAURD KNEE SYSTEM,6101164,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,14850.00,5940.00,,5940,40,,,percent of total billed charges,40% of total billed charges,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8910,60,,7128,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5940,40,,4752,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,12622.5,85,,10098,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,10395,70,,8316,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,4752,32,,3801.6,percent of total billed charges,32% of total billed charges,4752,12622.5,
SCREW 2.5MM,6101165,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2258.00,903.20,,,,,,other ,not seperately reimbursable,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1354.8,60,,1083.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,903.2,40,,722.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,1919.3,85,,1535.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,1580.6,70,,1264.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,722.56,32,,578.05,percent of total billed charges,32% of total billed charges,722.56,1919.3,
GRIT BLAST KNEE SYSTEM,6101167,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,4573.00,1829.20,,,,,,other ,not seperately reimbursable,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2743.8,60,,2195.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1829.2,40,,1463.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,3887.05,85,,3109.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,3201.1,70,,2560.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,1463.36,32,,1170.69,percent of total billed charges,32% of total billed charges,1463.36,3887.05,
VANGAURD 360 REVISION SYSTEM,6101171,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,3487.00,1394.80,,,,,,other ,not seperately reimbursable,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2092.2,60,,1673.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1394.8,40,,1115.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,2963.95,85,,2371.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,2440.9,70,,1952.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,1115.84,32,,892.67,percent of total billed charges,32% of total billed charges,1115.84,2963.95,
TIBAL TRAY,6101172,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,4752.00,1900.80,,,,,,other ,not seperately reimbursable,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,60,,2280.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1900.8,40,,1520.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,4039.2,85,,3231.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,3326.4,70,,2661.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,1520.64,32,,1216.51,percent of total billed charges,32% of total billed charges,1520.64,4039.2,
BIOMET 360 KNEE SYSTEM,6101173,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,3243.00,1297.20,,,,,,other ,not seperately reimbursable,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1945.8,60,,1556.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1297.2,40,,1037.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,2756.55,85,,2205.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,2270.1,70,,1816.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,1037.76,32,,830.21,percent of total billed charges,32% of total billed charges,1037.76,2756.55,
LABRAL TAPE,6101174,CDM,272,RC,,,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
SWIVELOCK 4.75 BC WITH FIBERTAP,6101178,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2431.00,972.40,,,,,,other ,not seperately reimbursable,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1458.6,60,,1166.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,972.4,40,,777.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,2066.35,85,,1653.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,1701.7,70,,1361.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,777.92,32,,622.34,percent of total billed charges,32% of total billed charges,777.92,2066.35,
SUTURE ANCHOR,6101179,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2728.00,1091.20,,,,,,other ,not seperately reimbursable,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1636.8,60,,1309.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1091.2,40,,872.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,2318.8,85,,1855.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,872.96,32,,698.37,percent of total billed charges,32% of total billed charges,872.96,2318.8,
TENODESIS SCREW,6101180,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1122.00,448.80,,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,673.2,60,,538.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,448.8,40,,359.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,953.7,85,,762.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,785.4,70,,628.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,32,,287.23,percent of total billed charges,32% of total billed charges,359.04,953.7,
FASTIN RC W/ORTHOCORD,6101182,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,971.00,388.40,,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,582.6,60,,466.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,388.4,40,,310.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,825.35,85,,660.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,679.7,70,,543.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,32,,248.58,percent of total billed charges,32% of total billed charges,310.72,825.35,
DRILL,6101189,CDM,272,RC,,,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,82.45,
PLATE T,6101199,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1004.00,401.60,,,,,,other ,not seperately reimbursable,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,602.4,60,,481.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,401.6,40,,321.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,853.4,85,,682.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,702.8,70,,562.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,321.28,32,,257.02,percent of total billed charges,32% of total billed charges,321.28,853.4,
DRILL BIT,6101200,CDM,272,RC,,,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
DRILL BIT,6101201,CDM,272,RC,,,OUTPATIENT,,,655.00,262.00,,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393,60,,314.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,262,40,,209.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,458.5,70,,366.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,556.75,
SCREW LO-PRO,6101203,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3124.00,1249.60,,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1874.4,60,,1499.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1249.6,40,,999.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,2655.4,85,,2124.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,2186.8,70,,1749.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,2655.4,
SCREW,6101204,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,336.00,134.40,,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,60,,161.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,134.4,40,,107.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,235.2,70,,188.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,285.6,
SCREW,6101205,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,550.00,220.00,,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330,60,,264,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,220,40,,176,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,467.5,85,,374,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,385,70,,308,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,467.5,
NAVIGATOR HANDLE,6101206,CDM,272,RC,,,OUTPATIENT,,,985.00,394.00,,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,591,60,,472.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,394,40,,315.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,837.25,85,,669.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,689.5,70,,551.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,837.25,
ZONE NAVIGATOR RIGHT,6101207,CDM,272,RC,,,OUTPATIENT,,,592.00,236.80,,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355.2,60,,284.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236.8,40,,189.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,414.4,70,,331.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,503.2,
SCREW,6101208,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,237.00,94.80,,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.2,60,,113.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,94.8,40,,75.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,165.9,70,,132.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,201.45,
THREADED GUIDE WIRE,6101209,CDM,272,RC,,,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
SCREW 5.0MM 16MM,6101210,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,955.00,382.00,,,,,,other ,not seperately reimbursable,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,573,60,,458.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,382,40,,305.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,811.75,85,,649.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,668.5,70,,534.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,305.6,32,,244.48,percent of total billed charges,32% of total billed charges,305.6,811.75,
DRILL CANNULATED,6101211,CDM,272,RC,,,OUTPATIENT,,,482.00,192.80,,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.2,60,,231.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,192.8,40,,154.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,409.7,85,,327.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,337.4,70,,269.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,409.7,
BONE TAP,6101212,CDM,272,RC,,,OUTPATIENT,,,482.00,192.80,,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.2,60,,231.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,192.8,40,,154.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,409.7,85,,327.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,337.4,70,,269.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,409.7,
DRILL 2.9MM,6101214,CDM,272,RC,,,OUTPATIENT,,,1128.00,451.20,,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676.8,60,,541.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,451.2,40,,360.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,958.8,85,,767.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,789.6,70,,631.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,958.8,
SCREW 3.5 48MM,6101216,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
SCREW 4.0,6101217,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
SCREW 4.0,6101218,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
K WIRE,6101223,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
K WIRE .062X5,6101224,CDM,272,RC,,,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,50.15,
DRILL BIT 2.0MM,6101225,CDM,272,RC,,,OUTPATIENT,,,2406.00,962.40,,,,,,other ,not seperately reimbursable,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1443.6,60,,1154.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,962.4,40,,769.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,2045.1,85,,1636.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,1684.2,70,,1347.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,769.92,32,,615.94,percent of total billed charges,32% of total billed charges,769.92,2045.1,
SUCTION MAT,6101232,CDM,272,RC,,,OUTPATIENT,,,286.00,114.40,,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.6,60,,137.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,243.1,
SCREW 4.0,6101233,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,770.00,308.00,,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,462,60,,369.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,308,40,,246.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,539,70,,431.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,654.5,
OXFORD PARTIAL KNEE SYSTEM,6101236,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,12582.00,5032.80,,5032.8,40,,,percent of total billed charges,40% of total billed charges,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7549.2,60,,6039.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5032.8,40,,4026.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,10694.7,85,,8555.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,8807.4,70,,7045.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,4026.24,32,,3220.99,percent of total billed charges,32% of total billed charges,4026.24,10694.7,
SCREW 3.2MM,6101246,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1546.00,618.40,,,,,,other ,not seperately reimbursable,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,927.6,60,,742.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,618.4,40,,494.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,1314.1,85,,1051.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,1082.2,70,,865.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,494.72,32,,395.78,percent of total billed charges,32% of total billed charges,494.72,1314.1,
SCREW 4.0,6101251,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,187.00,74.80,,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.2,60,,89.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.8,40,,59.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,130.9,70,,104.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,158.95,
EXCALIBUR 5.5MM,6101254,CDM,272,RC,,,OUTPATIENT,,,163.00,65.20,,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,60,,78.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.2,40,,52.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,114.1,70,,91.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,138.55,
BONE CUTTER 5.5MM,6101255,CDM,272,RC,,,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
BURR OVAL,6101256,CDM,272,RC,,,OUTPATIENT,,,146.00,58.40,,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.6,60,,70.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,102.2,70,,81.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,32,,37.38,percent of total billed charges,32% of total billed charges,46.72,124.1,
BIOCOMPOSITE PUSHLOK,6101257,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1600.00,640.00,,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,60,,768,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,640,40,,512,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,1360,85,,1088,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,1120,70,,896,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,1360,
SUTURE ANCHOR,6101258,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1494.00,597.60,,,,,,other ,not seperately reimbursable,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,896.4,60,,717.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,597.6,40,,478.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,1269.9,85,,1015.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,1045.8,70,,836.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,478.08,32,,382.46,percent of total billed charges,32% of total billed charges,478.08,1269.9,
SUTURE TAK KIT,6101259,CDM,272,RC,,,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
GLENOID CALIBRATOR,6101260,CDM,272,RC,,,OUTPATIENT,,,1081.00,432.40,,,,,,other ,not seperately reimbursable,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.6,60,,518.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,432.4,40,,345.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,918.85,85,,735.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,756.7,70,,605.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,345.92,32,,276.74,percent of total billed charges,32% of total billed charges,345.92,918.85,
PERCUTANEOUS INSERTOR KIT,6101261,CDM,272,RC,,,OUTPATIENT,,,866.00,346.40,,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,519.6,60,,415.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,346.4,40,,277.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,736.1,
CURVED TORPEDO,6101262,CDM,272,RC,,,OUTPATIENT,,,399.00,159.60,,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.4,60,,191.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,159.6,40,,127.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,279.3,70,,223.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,339.15,
APOLLORF XL90,6101263,CDM,272,RC,,,OUTPATIENT,,,600.00,240.00,,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,60,,288,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240,40,,192,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,420,70,,336,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,510,
CANNULA 7MM,6101266,CDM,272,RC,,,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
RETROCUTTER,6101267,CDM,272,RC,,,OUTPATIENT,,,768.00,307.20,,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,60,,368.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,307.2,40,,245.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,537.6,70,,430.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,32,,196.61,percent of total billed charges,32% of total billed charges,245.76,652.8,
SUTURE Y492G,6101268,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE Y922H,6101269,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE Y945H,6101270,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE Y946H,6101271,CDM,272,RC,,,OUTPATIENT,,,6.77,2.71,,,,,,other ,not seperately reimbursable,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.06,60,,3.25,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.71,40,,2.17,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,5.75,85,,4.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,4.74,70,,3.79,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,2.17,32,,1.74,percent of total billed charges,32% of total billed charges,2.17,5.75,
SUTURE Y397H,6101272,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE Y214H,6101273,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE Y218H,6101274,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE Y219H,6101275,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE Y606H,6101276,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J494G,6101277,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
COLLAGEN FIBORLOOP,6101278,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,297.00,118.80,,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,252.45,
SUTURE X524H,6101279,CDM,272,RC,,,OUTPATIENT,,,13.50,5.40,,,,,,other ,not seperately reimbursable,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.1,60,,6.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.4,40,,4.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,11.48,85,,9.18,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,9.45,70,,7.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,4.32,32,,3.46,percent of total billed charges,32% of total billed charges,4.32,11.48,
BONE CUTTER 5.0MM,6101280,CDM,272,RC,,,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
BONE CUTTER 5.0MM,6101281,CDM,272,RC,,,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
BONE CUTTER,6101282,CDM,272,RC,,,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
SCREW 4.0,6101289,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,608.00,243.20,,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364.8,60,,291.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.2,40,,194.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,516.8,85,,413.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,425.6,70,,340.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,32,,155.65,percent of total billed charges,32% of total billed charges,194.56,516.8,
SCREW 4.0,6101290,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,770.00,308.00,,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,462,60,,369.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,308,40,,246.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,539,70,,431.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,654.5,
CINCH CUTTER,6101293,CDM,272,RC,,,OUTPATIENT,,,493.00,197.20,,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295.8,60,,236.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,197.2,40,,157.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,345.1,70,,276.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,419.05,
CANNULA DRILL,6101295,CDM,272,RC,,,OUTPATIENT,,,1018.00,407.20,,,,,,other ,not seperately reimbursable,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,610.8,60,,488.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,407.2,40,,325.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,865.3,85,,692.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,712.6,70,,570.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,325.76,32,,260.61,percent of total billed charges,32% of total billed charges,325.76,865.3,
GUIDE PIN,6101296,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,82.45,
PLATE 3 HOLE,6101298,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1076.00,430.40,,,,,,other ,not seperately reimbursable,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,645.6,60,,516.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,430.4,40,,344.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,914.6,85,,731.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,753.2,70,,602.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,344.32,32,,275.46,percent of total billed charges,32% of total billed charges,344.32,914.6,
SCREW  HEADLESS,6101304,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2261.00,904.40,,,,,,other ,not seperately reimbursable,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1356.6,60,,1085.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,904.4,40,,723.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,1921.85,85,,1537.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,1582.7,70,,1266.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,723.52,32,,578.82,percent of total billed charges,32% of total billed charges,723.52,1921.85,
SCREW CORTEX,6101305,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,322.00,128.80,,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.2,60,,154.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,128.8,40,,103.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,225.4,70,,180.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,32,,82.43,percent of total billed charges,32% of total billed charges,103.04,273.7,
DRILL BIT,6101306,CDM,272,RC,,,OUTPATIENT,,,866.00,346.40,,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,519.6,60,,415.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,346.4,40,,277.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,736.1,
DRILL BIT,6101308,CDM,272,RC,,,OUTPATIENT,,,1216.00,486.40,,,,,,other ,not seperately reimbursable,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,729.6,60,,583.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,486.4,40,,389.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,1033.6,85,,826.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,851.2,70,,680.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,389.12,32,,311.3,percent of total billed charges,32% of total billed charges,389.12,1033.6,
TIBIAL BEARING,6101310,CDM,272,RC,,,OUTPATIENT,,,4009.50,1603.80,,,,,,other ,not seperately reimbursable,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2405.7,60,,1924.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1603.8,40,,1283.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,3408.08,85,,2726.46,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,2806.65,70,,2245.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,1283.04,32,,1026.43,percent of total billed charges,32% of total billed charges,1283.04,3408.08,
PIC LINE DSG KIT,6101311,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
MANOFOLD STRYKER,6101312,CDM,272,RC,,,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,39.95,
HIP BIODER,6101313,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,7744.00,3097.60,,3097.6,40,,,percent of total billed charges,40% of total billed charges,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4646.4,60,,3717.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3097.6,40,,2478.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,6582.4,85,,5265.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,5420.8,70,,4336.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,2478.08,32,,1982.46,percent of total billed charges,32% of total billed charges,2478.08,6582.4,
SAW BLADE,6101314,CDM,272,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
CABLE SLEEVE SET,6101315,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1606.00,642.40,,,,,,other ,not seperately reimbursable,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,963.6,60,,770.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,642.4,40,,513.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,1365.1,85,,1092.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,1124.2,70,,899.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,513.92,32,,411.14,percent of total billed charges,32% of total billed charges,513.92,1365.1,
TOURNIQUET 18,6101316,CDM,272,RC,,,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
TOURNIQUET 24,6101317,CDM,272,RC,,,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
TOURNIQUET 30,6101318,CDM,272,RC,,,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,50.15,
TOTAL HIP,6101319,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,22278.00,8911.20,,8911.2,40,,,percent of total billed charges,40% of total billed charges,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13366.8,60,,10693.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8911.2,40,,7128.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,18936.3,85,,15149.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,15594.6,70,,12475.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,7128.96,32,,5703.17,percent of total billed charges,32% of total billed charges,7128.96,18936.3,
TOURNIQUET 34,6101320,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
TOURNIQUET 44,6101321,CDM,272,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
TOURNIQUET DOUBLE,6101322,CDM,272,RC,,,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
K WIRE 1.98,6101323,CDM,272,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
ANTHOLOGY POROUS,6101324,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,21075.00,8430.00,,8430,40,,,percent of total billed charges,40% of total billed charges,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12645,60,,10116,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8430,40,,6744,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,17913.75,85,,14331,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,14752.5,70,,11802,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,6744,32,,5395.2,percent of total billed charges,32% of total billed charges,6744,17913.75,
SAW BLADE,6101325,CDM,272,RC,,,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
SCREW CORTICAL,6101326,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,206.00,82.40,,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.6,60,,98.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.4,40,,65.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,175.1,
TANDEM UNIPOLAR,6101327,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,900.00,360.00,,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540,60,,432,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,360,40,,288,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,765,85,,612,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,630,70,,504,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,765,
SCREW CORTICAL LAG,6101329,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
BIOCARTILAGE KIT,6101330,CDM,278,RC,,,OUTPATIENT,,,963.00,385.20,,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,577.8,60,,462.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,385.2,40,,308.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,674.1,70,,539.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,818.55,
TOOLS,6101331,CDM,272,RC,,,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.2,40,,96.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,257.55,
BIOCARTILAGE,6101332,CDM,278,RC,,,OUTPATIENT,,,2950.00,1180.00,,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,32,,755.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1770,60,,1416,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1180,40,,944,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,2507.5,85,,2006,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,32,,755.2,percent of total billed charges,32% of total billed charges,2065,70,,1652,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,32,,755.2,percent of total billed charges,32% of total billed charges,944,2507.5,
QUICK STIC,6101333,CDM,272,RC,,,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,80,40,,64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
INDWEL CATH,6101334,CDM,272,RC,,,OUTPATIENT,,,215.00,86.00,,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129,60,,103.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86,40,,68.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,150.5,70,,120.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,32,,55.04,percent of total billed charges,32% of total billed charges,68.8,182.75,
THROMBINATOR SYSTEM,6101335,CDM,278,RC,,,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
DISSECTOR,6101336,CDM,272,RC,,,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
APPLICATOR ASSEMBLY,6101337,CDM,272,RC,,,OUTPATIENT,,,217.00,86.80,,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.2,60,,104.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.8,40,,69.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,151.9,70,,121.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,32,,55.55,percent of total billed charges,32% of total billed charges,69.44,184.45,
EPOLY CHARGE,6101338,CDM,272,RC,C1776,HCPCS,OUTPATIENT,,,3314.00,1325.60,,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1988.4,60,,1590.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1325.6,40,,1060.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,2816.9,85,,2253.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,2319.8,70,,1855.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,2816.9,
TROCAR C0R50,6101339,CDM,272,RC,,,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,98.6,
TROCAR CTB71,6101340,CDM,272,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
TROCAR REPLACEMENT 6101340,6101341,CDM,272,RC,,,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,98.6,
TROCAR CTB01,6101342,CDM,272,RC,,,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
DUAL CANNULA,6101343,CDM,278,RC,,,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
DRILL PIN,6101344,CDM,272,RC,,,OUTPATIENT,,,825.00,330.00,,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495,60,,396,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,330,40,,264,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,701.25,85,,561,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,577.5,70,,462,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,701.25,
DRILL,6101345,CDM,272,RC,,,OUTPATIENT,,,473.00,189.20,,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.8,60,,227.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.2,40,,151.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,402.05,85,,321.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,331.1,70,,264.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,151.36,402.05,
SCREW LOCKING,6101346,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1130.00,452.00,,,,,,other ,not seperately reimbursable,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,678,60,,542.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,452,40,,361.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,960.5,85,,768.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,791,70,,632.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,361.6,32,,289.28,percent of total billed charges,32% of total billed charges,361.6,960.5,
SCREW,6101347,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,128.00,51.20,,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,60,,61.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,51.2,40,,40.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,89.6,70,,71.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,108.8,
GLENOID UNIVERSAL,6101348,CDM,278,RC,,,OUTPATIENT,,,1210.00,484.00,,,,,,other ,not seperately reimbursable,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,726,60,,580.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,484,40,,387.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,1028.5,85,,822.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,847,70,,677.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,387.2,32,,309.76,percent of total billed charges,32% of total billed charges,387.2,1028.5,
SCREW,6101349,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,468.00,187.20,,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280.8,60,,224.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,187.2,40,,149.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,397.8,85,,318.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,327.6,70,,262.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,32,,119.81,percent of total billed charges,32% of total billed charges,149.76,397.8,
PIN SET,6101350,CDM,272,RC,,,OUTPATIENT,,,811.00,324.40,,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.6,60,,389.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,689.35,85,,551.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,567.7,70,,454.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,32,,207.62,percent of total billed charges,32% of total billed charges,259.52,689.35,
CAGE SCREW,6101351,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,12169.00,4867.60,,4867.6,40,,,percent of total billed charges,40% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7301.4,60,,5841.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4867.6,40,,3894.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,10343.65,85,,8274.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,8518.3,70,,6814.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,10343.65,
ECLIPSE TRUNION,6101352,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,12169.00,4867.60,,4867.6,40,,,percent of total billed charges,40% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7301.4,60,,5841.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4867.6,40,,3894.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,10343.65,85,,8274.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,8518.3,70,,6814.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,32,,3115.26,percent of total billed charges,32% of total billed charges,3894.08,10343.65,
HUMERAL HEAD,6101353,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6300.00,2520.00,,2520,40,,,percent of total billed charges,40% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3780,60,,3024,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2520,40,,2016,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,5355,85,,4284,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,4410,70,,3528,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,32,,1612.8,percent of total billed charges,32% of total billed charges,2016,5355,
IMPLANT SYSTEM,6101354,CDM,271,RC,,,OUTPATIENT,,,7838.00,3135.20,,,,,,other ,not seperately reimbursable,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4702.8,60,,3762.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3135.2,40,,2508.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,6662.3,85,,5329.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,5486.6,70,,4389.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,2508.16,32,,2006.53,percent of total billed charges,32% of total billed charges,2508.16,6662.3,
SCREW,6101355,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,336.00,134.40,,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,60,,161.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,134.4,40,,107.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,235.2,70,,188.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,285.6,
ORTHOPEDIC 9/16 CIRCLE TAPER,6101358,CDM,272,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
PLATE PROX HUMN,6101359,CDM,272,RC,,,OUTPATIENT,,,3776.00,1510.40,,,,,,other ,not seperately reimbursable,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2265.6,60,,1812.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1510.4,40,,1208.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,3209.6,85,,2567.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,2643.2,70,,2114.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,1208.32,32,,966.66,percent of total billed charges,32% of total billed charges,1208.32,3209.6,
INCISOR BLADE,6101370,CDM,272,RC,,,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,49.6,40,,39.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,105.4,
DRILL BIT,6101374,CDM,272,RC,,,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
SCREW,6101377,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
SCP SIDE TARGETED SYSTEM,6101380,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,10381.25,4152.50,,4152.5,40,,,percent of total billed charges,40% of total billed charges,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6228.75,60,,4983,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4152.5,40,,3322,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,8824.06,85,,7059.25,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,7266.88,70,,5813.5,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,3322,32,,2657.6,percent of total billed charges,32% of total billed charges,3322,8824.06,
SCREW,6101381,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1238.00,495.20,,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,742.8,60,,594.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,495.2,40,,396.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,1052.3,85,,841.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,866.6,70,,693.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,1052.3,
DRILL BIT,6101382,CDM,272,RC,,,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
INTERNAL BRACE KI,6101383,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,4224.00,1689.60,,,,,,other ,not seperately reimbursable,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2534.4,60,,2027.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1689.6,40,,1351.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,3590.4,85,,2872.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,2956.8,70,,2365.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,1351.68,32,,1081.34,percent of total billed charges,32% of total billed charges,1351.68,3590.4,
BANANA KNIFE,6101384,CDM,272,RC,,,OUTPATIENT,,,394.00,157.60,,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.4,60,,189.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,157.6,40,,126.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,275.8,70,,220.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,334.9,
ACHILLES KIT,6101385,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,6837.00,2734.80,,2734.8,40,,,percent of total billed charges,40% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4102.2,60,,3281.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2734.8,40,,2187.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,5811.45,85,,4649.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,4785.9,70,,3828.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,5811.45,
CERAMIC HEAD BIOLOX,6101389,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6820.00,2728.00,,2728,40,,,percent of total billed charges,40% of total billed charges,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4092,60,,3273.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2728,40,,2182.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,5797,85,,4637.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,4774,70,,3819.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,2182.4,32,,1745.92,percent of total billed charges,32% of total billed charges,2182.4,5797,
TAPER ADAPTER,6101390,CDM,272,RC,,,OUTPATIENT,,,842.00,336.80,,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,505.2,60,,404.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,336.8,40,,269.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,715.7,
SPEED GRAFT,6101392,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6325.00,2530.00,,2530,40,,,percent of total billed charges,40% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3795,60,,3036,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2530,40,,2024,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,5376.25,85,,4301,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,4427.5,70,,3542,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,32,,1619.2,percent of total billed charges,32% of total billed charges,2024,5376.25,
JUGGER 1.0 MIMI 3-0,6101393,CDM,272,RC,,,OUTPATIENT,,,1265.00,506.00,,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,759,60,,607.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,506,40,,404.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,885.5,70,,708.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,1075.25,
MPJ PLATE  (MPP100),6101394,CDM,272,RC,,,OUTPATIENT,,,3300.00,1320.00,,,,,,other ,not seperately reimbursable,1056,32,,844.8,percent of total billed charges,32% of total billed charges,1056,32,,844.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1980,60,,1584,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1320,40,,1056,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1056,32,,844.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1056,32,,844.8,percent of total billed charges,32% of total billed charges,2805,85,,2244,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1056,32,,844.8,percent of total billed charges,32% of total billed charges,1056,32,,844.8,percent of total billed charges,32% of total billed charges,2310,70,,1848,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1056,32,,844.8,percent of total billed charges,32% of total billed charges,1056,32,,844.8,percent of total billed charges,32% of total billed charges,1056,2805,
2.0 SOLID DRILL  (MPN10020),6101395,CDM,272,RC,,,OUTPATIENT,,,371.00,148.40,,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.6,60,,178.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,148.4,40,,118.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,259.7,70,,207.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,315.35,
2.8 SOLID DRILL  (MPN10028),6101396,CDM,272,RC,,,OUTPATIENT,,,371.00,148.40,,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.6,60,,178.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,148.4,40,,118.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,259.7,70,,207.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,315.35,
1.6MM K-WIRES  (MPN10028),6101397,CDM,272,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
TEMPORARY FIXIATION PINS  (MPPF1115),6101398,CDM,272,RC,,,OUTPATIENT,,,206.00,82.40,,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.6,60,,98.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.4,40,,65.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,175.1,
JOINT FENESTRATION PIN  (MPDP0020),6101399,CDM,272,RC,,,OUTPATIENT,,,619.00,247.60,,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.4,60,,297.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,247.6,40,,198.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,526.15,85,,420.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,433.3,70,,346.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,526.15,
2.7x___ LOCKING SCREWS  (MPSL27),6101400,CDM,272,RC,,,OUTPATIENT,,,509.00,203.60,,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305.4,60,,244.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,203.6,40,,162.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,356.3,70,,285.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,432.65,
3.5x___ LOCKING SCREWS   (MPSL35),6101401,CDM,272,RC,,,OUTPATIENT,,,509.00,203.60,,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305.4,60,,244.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,203.6,40,,162.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,356.3,70,,285.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,32,,130.3,percent of total billed charges,32% of total billed charges,162.88,432.65,
3.5x___ NON LOCKING SCREW (MPSN35),6101402,CDM,272,RC,,,OUTPATIENT,,,399.00,159.60,,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.4,60,,191.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,159.6,40,,127.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,279.3,70,,223.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,32,,102.14,percent of total billed charges,32% of total billed charges,127.68,339.15,
INTRO KIT 8FR,6101410,CDM,272,RC,,,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
TIGER LOOP,6101414,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,212.00,84.80,,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.2,60,,101.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,84.8,40,,67.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,148.4,70,,118.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,180.2,
SCREW LOCKING,6101415,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,592.00,236.80,,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355.2,60,,284.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236.8,40,,189.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,414.4,70,,331.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,503.2,
SCREW FIXED LOCKING,6101416,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,174.00,69.60,,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,69.6,40,,55.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,147.9,
SCREW FIXED LOCKING,6101417,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,567.00,226.80,,,,,,other ,not seperately reimbursable,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340.2,60,,272.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,226.8,40,,181.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,481.95,85,,385.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,396.9,70,,317.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,181.44,32,,145.15,percent of total billed charges,32% of total billed charges,181.44,481.95,
SHOULDER GLENSPHERE,6101418,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,5534.00,2213.60,,2213.6,40,,,percent of total billed charges,40% of total billed charges,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3320.4,60,,2656.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2213.6,40,,1770.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,4703.9,85,,3763.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,3873.8,70,,3099.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,1770.88,32,,1416.7,percent of total billed charges,32% of total billed charges,1770.88,4703.9,
SCREW DRILL BIT,6101419,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,759.00,303.60,,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455.4,60,,364.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,303.6,40,,242.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,645.15,
PLATE ANATOMIC,6101420,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3190.00,1276.00,,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1914,60,,1531.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1276,40,,1020.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,2711.5,85,,2169.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,2233,70,,1786.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,32,,816.64,percent of total billed charges,32% of total billed charges,1020.8,2711.5,
SCREW,6101421,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,820.00,328.00,,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492,60,,393.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,328,40,,262.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,697,85,,557.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,574,70,,459.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,697,
SCREW 3.5MM,6101423,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
SCREW 4.0,6101425,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,525.00,210.00,,,,,,other ,not seperately reimbursable,168,32,,134.4,percent of total billed charges,32% of total billed charges,168,32,,134.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315,60,,252,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,210,40,,168,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,168,32,,134.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,32,,134.4,percent of total billed charges,32% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,32,,134.4,percent of total billed charges,32% of total billed charges,168,32,,134.4,percent of total billed charges,32% of total billed charges,367.5,70,,294,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,168,32,,134.4,percent of total billed charges,32% of total billed charges,168,32,,134.4,percent of total billed charges,32% of total billed charges,168,446.25,
CINCH,6101426,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1554.00,621.60,,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.4,60,,745.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,621.6,40,,497.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,1320.9,85,,1056.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,1087.8,70,,870.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,32,,397.82,percent of total billed charges,32% of total billed charges,497.28,1320.9,
MODULAR REVISION SYSTEM,6101427,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,11700.00,4680.00,,4680,40,,,percent of total billed charges,40% of total billed charges,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7020,60,,5616,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4680,40,,3744,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,9945,85,,7956,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,8190,70,,6552,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,3744,32,,2995.2,percent of total billed charges,32% of total billed charges,3744,9945,
MODULAR REVISION SYSTEM,6101428,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,22550.00,9020.00,,9020,40,,,percent of total billed charges,40% of total billed charges,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13530,60,,10824,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9020,40,,7216,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,19167.5,85,,15334,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,15785,70,,12628,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,7216,32,,5772.8,percent of total billed charges,32% of total billed charges,7216,19167.5,
MODULAR HEAD,6101429,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,3988.00,1595.20,,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2392.8,60,,1914.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1595.2,40,,1276.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,3389.8,85,,2711.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,2791.6,70,,2233.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,32,,1020.93,percent of total billed charges,32% of total billed charges,1276.16,3389.8,
KNEE KIT,6101430,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,121.00,48.40,,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.6,60,,58.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,84.7,70,,67.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,102.85,
CANNULA,6101431,CDM,271,RC,,,OUTPATIENT,,,1265.00,506.00,,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,759,60,,607.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,506,40,,404.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,885.5,70,,708.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,32,,323.84,percent of total billed charges,32% of total billed charges,404.8,1075.25,
IMPLANT SYSTEM,6101432,CDM,271,RC,,,OUTPATIENT,,,8300.00,3320.00,,,,,,other ,not seperately reimbursable,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4980,60,,3984,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3320,40,,2656,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,7055,85,,5644,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,5810,70,,4648,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,2656,32,,2124.8,percent of total billed charges,32% of total billed charges,2656,7055,
MIXING SYSTEM,6101433,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,620.00,248.00,,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372,60,,297.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,248,40,,198.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,527,85,,421.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,434,70,,347.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,527,
ARTICULATION,6101434,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6672.00,2668.80,,2668.8,40,,,percent of total billed charges,40% of total billed charges,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4003.2,60,,3202.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2668.8,40,,2135.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,5671.2,85,,4536.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,4670.4,70,,3736.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,2135.04,32,,1708.03,percent of total billed charges,32% of total billed charges,2135.04,5671.2,
RCLAGE COCR 1.8MM,6101435,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1915.00,766.00,,,,,,other ,not seperately reimbursable,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1149,60,,919.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,766,40,,612.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,1627.75,85,,1302.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,612.8,32,,490.24,percent of total billed charges,32% of total billed charges,612.8,1627.75,
SCREW,6101436,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3124.00,1249.60,,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1874.4,60,,1499.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1249.6,40,,999.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,2655.4,85,,2124.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,2186.8,70,,1749.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,32,,799.74,percent of total billed charges,32% of total billed charges,999.68,2655.4,
CANNULA CUTTER,6101437,CDM,272,RC,,,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
CANNULA CUTTER,6101438,CDM,272,RC,,,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
FLIP CUTTER,6101439,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1631.00,652.40,,,,,,other ,not seperately reimbursable,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,978.6,60,,782.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,652.4,40,,521.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,1386.35,85,,1109.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,1141.7,70,,913.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,521.92,32,,417.54,percent of total billed charges,32% of total billed charges,521.92,1386.35,
TIGHTROPE BTB,6101440,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2662.00,1064.80,,,,,,other ,not seperately reimbursable,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1597.2,60,,1277.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1064.8,40,,851.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,2262.7,85,,1810.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,1863.4,70,,1490.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,851.84,32,,681.47,percent of total billed charges,32% of total billed charges,851.84,2262.7,
TIGHTROPE,6101441,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3070.00,1228.00,,,,,,other ,not seperately reimbursable,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1842,60,,1473.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1228,40,,982.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,2609.5,85,,2087.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,2149,70,,1719.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,982.4,32,,785.92,percent of total billed charges,32% of total billed charges,982.4,2609.5,
ACCORD 2.0 MM CABLE W/CLAMP,6101442,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,4180.00,1672.00,,,,,,other ,not seperately reimbursable,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2508,60,,2006.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1672,40,,1337.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,3553,85,,2842.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,2926,70,,2340.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,1337.6,32,,1070.08,percent of total billed charges,32% of total billed charges,1337.6,3553,
SCREW LO PRO 4x44 MM,6101443,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,649.00,259.60,,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389.4,60,,311.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259.6,40,,207.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,454.3,70,,363.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,32,,166.14,percent of total billed charges,32% of total billed charges,207.68,551.65,
"LOCK PLATE, DISTAL FIBULA, LT",6101444,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2200.00,880.00,,,,,,other ,not seperately reimbursable,704,32,,563.2,percent of total billed charges,32% of total billed charges,704,32,,563.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1320,60,,1056,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,880,40,,704,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,704,32,,563.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,704,32,,563.2,percent of total billed charges,32% of total billed charges,1870,85,,1496,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,704,32,,563.2,percent of total billed charges,32% of total billed charges,704,32,,563.2,percent of total billed charges,32% of total billed charges,1540,70,,1232,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,704,32,,563.2,percent of total billed charges,32% of total billed charges,704,32,,563.2,percent of total billed charges,32% of total billed charges,704,1870,
"LOCK PLATE, MEDIAL HOOK",6101445,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3242.00,1296.80,,,,,,other ,not seperately reimbursable,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1945.2,60,,1556.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1296.8,40,,1037.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,2755.7,85,,2204.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,2269.4,70,,1815.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,1037.44,32,,829.95,percent of total billed charges,32% of total billed charges,1037.44,2755.7,
DRILL BIT,6101446,CDM,272,RC,,,OUTPATIENT,,,413.00,165.20,,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.8,60,,198.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,351.05,85,,280.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,289.1,70,,231.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,351.05,
WIRE,6101447,CDM,272,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
PROFILE DRILL,6101448,CDM,272,RC,,,OUTPATIENT,,,413.00,165.20,,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.8,60,,198.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,351.05,85,,280.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,289.1,70,,231.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,351.05,
SCREW,6101449,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,944.00,377.60,,,,,,other ,not seperately reimbursable,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,566.4,60,,453.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.6,40,,302.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,802.4,85,,641.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,660.8,70,,528.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,302.08,32,,241.66,percent of total billed charges,32% of total billed charges,302.08,802.4,
SCREW  AR-8740-32H,6101450,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1055.00,422.00,,,,,,other ,not seperately reimbursable,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,633,60,,506.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,422,40,,337.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,896.75,85,,717.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,738.5,70,,590.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,337.6,32,,270.08,percent of total billed charges,32% of total billed charges,337.6,896.75,
SCREW  AR8944 MC-18,6101451,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1238.00,495.20,,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,742.8,60,,594.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,495.2,40,,396.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,1052.3,85,,841.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,866.6,70,,693.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,32,,316.93,percent of total billed charges,32% of total billed charges,396.16,1052.3,
BIOCOMPOSITE ACHILLES SPEEDBRIDGE,6101452,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,8229.38,3291.75,,3291.75,40,,,percent of total billed charges,40% of total billed charges,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4937.63,60,,3950.1,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3291.75,40,,2633.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,6994.97,85,,5595.98,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,5760.57,70,,4608.46,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,2633.4,32,,2106.72,percent of total billed charges,32% of total billed charges,2633.4,6994.97,
DYNANITE NITI STAPLE W/INSTRUMENTS,6101453,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,9017.00,3606.80,,3606.8,40,,,percent of total billed charges,40% of total billed charges,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5410.2,60,,4328.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3606.8,40,,2885.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,7664.45,85,,6131.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,6311.9,70,,5049.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,2885.44,32,,2308.35,percent of total billed charges,32% of total billed charges,2885.44,7664.45,
G-WIRE W/TRCR TIP,6101454,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,163.00,65.20,,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,60,,78.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.2,40,,52.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,114.1,70,,91.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,138.55,
ARTHRS KNEE LATERAL RELEASE,6101500,CDM,360,RC,29882,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,896.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,896.93,5046.45,
ARTHRS KNEE INFECTION LAVAGE & DRAINAGE,6101501,CDM,360,RC,29871,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,668.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,668.68,5046.45,
ARTHRS KNEE W/MENISCUS RPR MED OR LAT,6101502,CDM,360,RC,29882,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,896.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,896.93,5046.45,
ARTHRS KNEE W/MENISCUS RPR MED AND LAT,6101503,CDM,360,RC,29883,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1096.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,5046.45,
ARTHRS KNEE DX W/WO SYNOVIAL BX SPX,6101504,CDM,360,RC,29870,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,705.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,705.55,5046.45,
ARTHRS KNEE W/LYSIS ADHESIONS W/WO MANJ,6101505,CDM,360,RC,29884,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,804.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,804.23,5046.45,
ARTHRS KNEE DRILLING OSTEOCHOND DISSECAN,6101506,CDM,360,RC,29886,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,828.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,828.03,5046.45,
ARTHRS KNEE DRLG OSTEOCHOND DISSECANS IN,6101507,CDM,360,RC,29887,HCPCS,OUTPATIENT,,,12583.00,5033.20,,3000,100,,,case rate,pays based on per visit rate,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7549.8,60,,6039.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,981.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,10695.55,85,,8556.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,8808.1,70,,7046.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,981.1,10695.55,
ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR C,6101508,CDM,360,RC,29877,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,808.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,808.99,5046.45,
ARTHRS KNEE SYNOVECTOMY LIMITED SPX,6101509,CDM,360,RC,29875,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,645.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,645.04,5046.45,
ARTHRS KNEE SYNOVECTOMY 2/>COMPARTMENTS,6101510,CDM,360,RC,29876,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,850.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,850.81,5046.45,
ARTHRS KNEE RMVL LOOSE/FOREIGN BODY,6101511,CDM,360,RC,29874,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,697.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,697.71,5046.45,
ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MIC,6101512,CDM,360,RC,29879,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,861.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,861.74,5046.45,
ARTHRS KNEE W/MENISC MED&LAT W/SHAVING,6101513,CDM,360,RC,29880,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,730.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,730.8,5046.45,
ARTHRS KNE SURG W/MENISC MED/LAT W/SHVG,6101514,CDM,360,RC,29881,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,703.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,703.58,5046.45,
LAP SURG CHOLECYSTECTOMY,6101515,CDM,360,RC,47562,HCPCS,OUTPATIENT,,,10078.00,4031.20,,3000,100,,,case rate,pays based on per visit rate,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6046.8,60,,4837.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,886.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,8566.3,85,,6853.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,7054.6,70,,5643.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,886.25,8566.3,
LAP SURG CHOLECYSTECTOMY W/CHOLANGIOGRA,6101516,CDM,360,RC,47563,HCPCS,OUTPATIENT,,,10078.00,4031.20,,3000,100,,,case rate,pays based on per visit rate,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6046.8,60,,4837.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,964.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,8566.3,85,,6853.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,7054.6,70,,5643.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,964.71,8566.3,
LAP SURG CHOLECSTC W/EXPL COMMON DUCT,6101517,CDM,360,RC,47564,HCPCS,OUTPATIENT,,,10074.00,4029.60,,3000,100,,,case rate,pays based on per visit rate,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6044.4,60,,4835.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1498.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,8562.9,85,,6850.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,7051.8,70,,5641.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,3223.68,32,,2578.94,percent of total billed charges,32% of total billed charges,1498.03,8562.9,
ARTHRS SHOULDER SURG SYNOVECTOMY PARTIAL,6101518,CDM,360,RC,29820,HCPCS,OUTPATIENT,,,12583.00,5033.20,,3000,100,,,case rate,pays based on per visit rate,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7549.8,60,,6039.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,698.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,10695.55,85,,8556.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,8808.1,70,,7046.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,4026.56,32,,3221.25,percent of total billed charges,32% of total billed charges,698.15,10695.55,
ARTHRS SHOULDER SURG SYNOVECTOMY COMPLET,6101519,CDM,360,RC,29821,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,773.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,773.86,5046.45,
ARTHRS SHOULDER SURG DEBRIDEMENT LIMITED,6101520,CDM,360,RC,29822,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,703.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,703.36,5046.45,
ARTHRS SHOULDER SURG DEBRIDEMENT EXTENSI,6101521,CDM,360,RC,29823,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,771.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,771.25,5046.45,
ARTHRS SHOULDER AHESIOLYSIS W/WO MANIPJ,6101522,CDM,360,RC,29825,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,763.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,763.4,5046.45,
ARTHRS SHOULDER SURGICAL RMVL LOOSE/FB,6101523,CDM,360,RC,29819,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,763.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,763.61,4948.7,
ARTHRS SHOULDER DX W/WO SYNOVIAL BIOPSY,6101524,CDM,360,RC,29805,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,608.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,608.26,5046.45,
ARTHRS SHOULDER DISTAL CLAVICULECTOMY,6101525,CDM,360,RC,29824,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,880.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,880.35,5046.45,
ARTHROPLASTY KNEE TIBIAL PLATEAU,6101526,CDM,360,RC,27440,HCPCS,OUTPATIENT,,,22720.00,9088.00,,3000,100,,,case rate,pays based on per visit rate,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,13632,60,,10905.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1042.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,19312,85,,15449.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,15904,70,,12723.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,19312,
ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU,6101527,CDM,360,RC,27442,HCPCS,OUTPATIENT,,,22720.00,9088.00,,3000,100,,,case rate,pays based on per visit rate,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,13632,60,,10905.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1138.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,19312,85,,15449.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,15904,70,,12723.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,19312,
ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT C,6101528,CDM,360,RC,27446,HCPCS,OUTPATIENT,,,22720.00,9088.00,,3000,100,,,case rate,pays based on per visit rate,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13632,60,,10905.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1511.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,19312,85,,15449.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,15904,70,,12723.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,1511.08,19312,
ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL S,6101529,CDM,360,RC,27441,HCPCS,OUTPATIENT,,,22720.00,9088.00,,3000,100,,,case rate,pays based on per visit rate,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,13632,60,,10905.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1076.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,19312,85,,15449.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,15904,70,,12723.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,19312,
ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDM,6101530,CDM,360,RC,27443,HCPCS,OUTPATIENT,,,22720.00,9088.00,,3000,100,,,case rate,pays based on per visit rate,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,13632,60,,10905.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1066.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,19312,85,,15449.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,15904,70,,12723.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,7270.4,32,,5816.32,percent of total billed charges,32% of total billed charges,674,19312,
NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL,6101531,CDM,360,RC,64721,HCPCS,OUTPATIENT,,,3615.00,1446.00,,3000,100,,,case rate,pays based on per visit rate,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2169,60,,1735.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,571.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,3072.75,85,,2458.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,2530.5,70,,2024.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,1156.8,32,,925.44,percent of total billed charges,32% of total billed charges,419,3072.75,
REPAIR INCOMPLETE CIRCUMCISION,6101532,CDM,360,RC,54163,HCPCS,OUTPATIENT,,,3806.00,1522.40,,3000,100,,,case rate,pays based on per visit rate,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2283.6,60,,1826.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,276.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,3235.1,85,,2588.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,2664.2,70,,2131.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,276.89,3235.1,
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,6101533,CDM,360,RC,54150,HCPCS,OUTPATIENT,,,3806.00,1522.40,,3000,100,,,case rate,pays based on per visit rate,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2283.6,60,,1826.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,3235.1,85,,2588.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,2664.2,70,,2131.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,189.91,3235.1,
LYSIS/EXCISION PENILE POSTCIRCUMCISION A,6101534,CDM,360,RC,54162,HCPCS,OUTPATIENT,,,3806.00,1522.40,,3000,100,,,case rate,pays based on per visit rate,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2283.6,60,,1826.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,327.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,3235.1,85,,2588.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,2664.2,70,,2131.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,327.66,3235.1,
CIRCUMCISION AGE >28 DAYS,6101535,CDM,360,RC,54161,HCPCS,OUTPATIENT,,,3806.00,1522.40,,3000,100,,,case rate,pays based on per visit rate,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2283.6,60,,1826.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,3235.1,85,,2588.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,2664.2,70,,2131.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,1217.92,32,,974.34,percent of total billed charges,32% of total billed charges,252.11,3235.1,
I&D ABSCESS PERITONSILLAR,6101536,CDM,360,RC,42700,HCPCS,OUTPATIENT,,,401.00,160.40,,3000,100,,,case rate,pays based on per visit rate,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,240.6,60,,192.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,280.7,70,,224.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,128.32,32,,102.66,percent of total billed charges,32% of total billed charges,128.32,3000,
I&D PILONIDAL CYST COMPLICATED,6101537,CDM,360,RC,10081,HCPCS,OUTPATIENT,,,1286.00,514.40,,3000,100,,,case rate,pays based on per visit rate,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,440.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,3000,
I&D PILONIDAL CYST SIMPLE,6101538,CDM,360,RC,10080,HCPCS,OUTPATIENT,,,1286.00,514.40,,3000,100,,,case rate,pays based on per visit rate,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,320.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,320.68,3000,
I&D COMPLEX PO WOUND INFECTION,6101539,CDM,360,RC,10180,HCPCS,OUTPATIENT,,,5218.00,2087.20,,3000,100,,,case rate,pays based on per visit rate,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3130.8,60,,2504.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,336.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,4435.3,85,,3548.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,3652.6,70,,2922.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,336.86,4435.3,
I&D HEMATOMA SEROMA/FLUID COLLECTION,6101540,CDM,360,RC,10140,HCPCS,OUTPATIENT,,,3026.00,1210.40,,3000,100,,,case rate,pays based on per visit rate,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1815.6,60,,1452.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,214.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2572.1,85,,2057.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2118.2,70,,1694.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,214.61,3000,
I&D OF BARTHOLINS GLAND ABSCESS,6101541,CDM,360,RC,56420,HCPCS,OUTPATIENT,,,361.00,144.40,,3000,100,,,case rate,pays based on per visit rate,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.6,60,,173.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,238.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,252.7,70,,202.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,3000,
I&D VULVA/PERINEAL ABSCESS,6101542,CDM,360,RC,56405,HCPCS,OUTPATIENT,,,602.00,240.80,,3000,100,,,case rate,pays based on per visit rate,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,361.2,60,,288.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,190.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,511.7,85,,409.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,421.4,70,,337.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,190.86,3000,
I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA,6101543,CDM,360,RC,25028,HCPCS,OUTPATIENT,,,5937.00,2374.80,,3000,100,,,case rate,pays based on per visit rate,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3562.2,60,,2849.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,896.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,5046.45,85,,4037.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,4155.9,70,,3324.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,1899.84,32,,1519.87,percent of total billed charges,32% of total billed charges,312,5046.45,
I&D SUBMUCOSAL ABSCESS RECTUM,6101544,CDM,360,RC,45005,HCPCS,OUTPATIENT,,,2102.00,840.80,,3000,100,,,case rate,pays based on per visit rate,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1261.2,60,,1008.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,412.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1786.7,85,,1429.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1471.4,70,,1177.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,412.71,3000,
I&D DP SUPRALEVATOR PELVIRCT/RETRORCT AB,6101545,CDM,360,RC,45020,HCPCS,OUTPATIENT,,,5197.00,2078.80,,3000,100,,,case rate,pays based on per visit rate,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3118.2,60,,2494.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,753.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,4417.45,85,,3533.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,3637.9,70,,2910.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,419,4417.45,
I&D LEG/ANKLE ABSCESS/HEMATOMA,6101546,CDM,360,RC,27603,HCPCS,OUTPATIENT,,,5218.00,2087.20,,3000,100,,,case rate,pays based on per visit rate,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3130.8,60,,2504.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,683.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,4435.3,85,,3548.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,3652.6,70,,2922.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,419,4435.3,
I&D SHOULDER DEEP ABSCESS/HEMATOMA,6101547,CDM,360,RC,23030,HCPCS,OUTPATIENT,,,5218.00,2087.20,,3000,100,,,case rate,pays based on per visit rate,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3130.8,60,,2504.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,565.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,4435.3,85,,3548.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,3652.6,70,,2922.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,312,4435.3,
I&D THYROGLOSSAL DUCT CYST INFECTED,6101548,CDM,360,RC,60000,HCPCS,OUTPATIENT,,,2555.00,1022.00,,3000,100,,,case rate,pays based on per visit rate,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1533,60,,1226.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,233.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,2171.75,85,,1737.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,1788.5,70,,1430.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,817.6,32,,654.08,percent of total billed charges,32% of total billed charges,233.14,3000,
RPR RECRT INGUINAL HERNIA ANY AGE REDUCI,6101549,CDM,360,RC,49520,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,850.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,850.33,5553.9,
RPR INGUN HERNIA SLIDING ANY AGE,6101550,CDM,360,RC,49525,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,768.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,5553.9,
RPR RECRT INGUN HERNIA ANY AGE INCARCERA,6101551,CDM,360,RC,49521,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,961.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,961.69,5553.9,
RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE,6101552,CDM,360,RC,49505,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,699.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,5553.9,
RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERA,6101553,CDM,360,RC,49507,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,785.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,785.91,5553.9,
RPR RECRT FEM HERNIA REDUCIBLE,6101554,CDM,360,RC,49555,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,812.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,674,5553.9,
LAPS REPAIR INCISIONAL HERNIA REDUCIBLE,6101555,CDM,360,RC,49654,HCPCS,OUTPATIENT,,,17047.00,6818.80,,3000,100,,,case rate,pays based on per visit rate,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10228.2,60,,8182.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1133.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,14489.95,85,,11591.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,11932.9,70,,9546.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,1133.85,14489.95,
LAPS RPR INCISIONAL HERNIA NCRC8/STRANGU,6101556,CDM,360,RC,49655,HCPCS,OUTPATIENT,,,17047.00,6818.80,,3000,100,,,case rate,pays based on per visit rate,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10228.2,60,,8182.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1390.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,14489.95,85,,11591.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,11932.9,70,,9546.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,1390.05,14489.95,
LAPS RPR RECURRENT INCISIONAL HERNIA RED,6101557,CDM,360,RC,49656,HCPCS,OUTPATIENT,,,17047.00,6818.80,,3000,100,,,case rate,pays based on per visit rate,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10228.2,60,,8182.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1233.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,14489.95,85,,11591.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,11932.9,70,,9546.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,1233.4,14489.95,
LAPS RPR RECURRENT INCAL HRNA NCRC8/STRA,6101558,CDM,360,RC,49657,HCPCS,OUTPATIENT,,,17047.00,6818.80,,3000,100,,,case rate,pays based on per visit rate,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10228.2,60,,8182.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1773.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,14489.95,85,,11591.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,11932.9,70,,9546.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,5455.04,32,,4364.03,percent of total billed charges,32% of total billed charges,1773.63,14489.95,
LAPS REPAIR HERNIA EXCEPT INCAL/INGUN RE,6101559,CDM,360,RC,49652,HCPCS,OUTPATIENT,,,10078.00,4031.20,,3000,100,,,case rate,pays based on per visit rate,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6046.8,60,,4837.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,998.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,8566.3,85,,6853.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,7054.6,70,,5643.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,998.11,8566.3,
LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRA,6101560,CDM,360,RC,49653,HCPCS,OUTPATIENT,,,10078.00,4031.20,,3000,100,,,case rate,pays based on per visit rate,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6046.8,60,,4837.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1251.09,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,8566.3,85,,6853.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,7054.6,70,,5643.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,1251.09,8566.3,
RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE,6101561,CDM,360,RC,49580,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,446.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,446.26,5553.9,
RPR UMBILICAL HERNIA < 5 YRS INCARCERATE,6101562,CDM,360,RC,49582,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,649.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,649.46,5553.9,
RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCE,6101563,CDM,360,RC,49587,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,637.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,5553.9,
RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE,6101564,CDM,360,RC,49585,HCPCS,OUTPATIENT,,,6534.00,2613.60,,3000,100,,,case rate,pays based on per visit rate,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3920.4,60,,3136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,596.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,5553.9,85,,4443.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,4573.8,70,,3659.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,2090.88,32,,1672.7,percent of total billed charges,32% of total billed charges,591,5553.9,
LAPAROSCOPIC APPENDECTOMY,6101565,CDM,360,RC,44970,HCPCS,OUTPATIENT,,,10078.00,4031.20,,3000,100,,,case rate,pays based on per visit rate,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6046.8,60,,4837.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,806.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,8566.3,85,,6853.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,7054.6,70,,5643.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,3224.96,32,,2579.97,percent of total billed charges,32% of total billed charges,806.04,8566.3,
ABDOM PARACENTESIS DX/THER W/O IMAGING G,6101566,CDM,360,RC,49082,HCPCS,OUTPATIENT,,,1669.00,667.60,,3000,100,,,case rate,pays based on per visit rate,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1001.4,60,,801.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,270.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1168.3,70,,934.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,270.55,3000,
ABDOM PARACENTESIS DX/THER W/IMAGING GUI,6101567,CDM,360,RC,49083,HCPCS,OUTPATIENT,,,1669.00,667.60,,3000,100,,,case rate,pays based on per visit rate,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1001.4,60,,801.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,373.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1168.3,70,,934.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,373.7,3000,
PERITONEAL LAVAGE W/WO IMAGING GUIDANCE,6101568,CDM,360,RC,49084,HCPCS,OUTPATIENT,,,1669.00,667.60,,3000,100,,,case rate,pays based on per visit rate,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1001.4,60,,801.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,142.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1168.3,70,,934.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,142.64,3000,
ICAPSULAR CATARACT XTRJ INSJ IO LENS PRS,6101569,CDM,360,RC,66983,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,923,3665.2,
CATARACT RMVL INSERTION OF LENS,6101570,CDM,360,RC,66984,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,670.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,670.75,3665.2,
XCAPSULAR CATARACT RMVL INSJ LENS PROSTH,6101571,CDM,360,RC,66982,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,919.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,919.31,3665.2,
INSJ IO LENS PROSTHESIS NOT W/CONCURRENT,6101572,CDM,360,RC,66985,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,785,100,,,fee schedule,100% of BCBS ASC tier groupings rate,785,100,,,fee schedule,100% of BCBS ASC tier groupings rate,785,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,947.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,785,3665.2,
RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCT,6101573,CDM,360,RC,66830,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,874.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,591,3665.2,
RMVL LENS MATERIAL PHACOFRAGMENTATION AS,6101574,CDM,360,RC,66850,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,970.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,935,3665.2,
RMVL LENS MATERIAL INTRACAPSULAR,6101575,CDM,360,RC,66920,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,922.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,591,3665.2,
RMVL LENS MATERIAL EXTRACAPSULAR,6101576,CDM,360,RC,66940,HCPCS,OUTPATIENT,,,4312.00,1724.80,,3000,100,,,case rate,pays based on per visit rate,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2587.2,60,,2069.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,966.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,3018.4,70,,2414.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,1379.84,32,,1103.87,percent of total billed charges,32% of total billed charges,674,3665.2,
EXC B9 LESION MRGN XCP SK TG FEENLM 0.5C,6101577,CDM,360,RC,11440,HCPCS,OUTPATIENT,,,1286.00,514.40,,3000,100,,,case rate,pays based on per visit rate,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,178.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,178.98,3000,
EXC B9 LESION MRGN XCP SK TG FEENLM > 4.,6101578,CDM,360,RC,11446,HCPCS,OUTPATIENT,,,5218.00,2087.20,,3000,100,,,case rate,pays based on per visit rate,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3130.8,60,,2504.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,493.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,4435.3,85,,3548.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,3652.6,70,,2922.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,1669.76,32,,1335.81,percent of total billed charges,32% of total billed charges,419,4435.3,
EXC B9 LES MRGN XCP SK TG FEENLM 0.6-1.0,6101579,CDM,360,RC,11441,HCPCS,OUTPATIENT,,,1286.00,514.40,,3000,100,,,case rate,pays based on per visit rate,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,219.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,219.54,3000,
EXC B9 LES MRGN XCP SK TG FEENLM 1.1-2.0,6101580,CDM,360,RC,11442,HCPCS,OUTPATIENT,,,1286.00,514.40,,3000,100,,,case rate,pays based on per visit rate,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,243.78,3000,
EXC B9 LES MRGN XCP SK TG FEENLM 2.1-3.0,6101581,CDM,360,RC,11443,HCPCS,OUTPATIENT,,,3026.00,1210.40,,3000,100,,,case rate,pays based on per visit rate,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1815.6,60,,1452.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,288.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2572.1,85,,2057.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2118.2,70,,1694.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,288.84,3000,
EXC B9 LES MRGN XCP SK TG FEENLM 3.1-4.0,6101582,CDM,360,RC,11444,HCPCS,OUTPATIENT,,,3026.00,1210.40,,3000,100,,,case rate,pays based on per visit rate,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1815.6,60,,1452.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,360.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2572.1,85,,2057.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2118.2,70,,1694.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,312,3000,
RMVL SKN TAGS MLT FIBRQ TAGS ANY AREA UP,6101583,CDM,360,RC,11200,HCPCS,OUTPATIENT,,,379.00,151.60,,3000,100,,,case rate,pays based on per visit rate,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.4,60,,181.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,265.3,70,,212.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,112.54,3000,
ARTHO KNEE W/LYSIS OF ADHESIONS,6101584,CDM,360,RC,29884,HCPCS,OUTPATIENT,,,2645.00,1058.00,,3000,100,,,case rate,pays based on per visit rate,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1587,60,,1269.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,804.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,2248.25,85,,1798.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,1851.5,70,,1481.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,846.4,32,,677.12,percent of total billed charges,32% of total billed charges,804.23,3000,
TISS TRNFR FCCMNAG HNDS/FT 10.1 -30.0CM,6101585,CDM,360,RC,14001,HCPCS,OUTPATIENT,,,3521.00,1408.40,,3000,100,,,case rate,pays based on per visit rate,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2112.6,60,,1690.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1030.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2992.85,85,,2394.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2464.7,70,,1971.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,3000,
EXC/TRANSPOSITION PTERYGIUM W/O GRAFT,6101586,CDM,360,RC,65420,HCPCS,OUTPATIENT,,,4067.00,1626.80,,3000,100,,,case rate,pays based on per visit rate,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2440.2,60,,1952.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,666.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,3456.95,85,,2765.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,2846.9,70,,2277.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,419,3456.95,
"REPAIR ECTROPION, EXTENSIVE",6101587,CDM,360,RC,67917,HCPCS,OUTPATIENT,,,4067.00,1626.80,,3000,100,,,case rate,pays based on per visit rate,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2440.2,60,,1952.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,777.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,3456.95,85,,2765.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,2846.9,70,,2277.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,1301.44,32,,1041.15,percent of total billed charges,32% of total billed charges,591,3456.95,
BLEPHAROPLASTY UPPER EYELID,6101588,CDM,360,RC,15823,HCPCS,OUTPATIENT,,,3521.00,1408.40,,3000,100,,,case rate,pays based on per visit rate,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2112.6,60,,1690.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,772.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2992.85,85,,2394.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2464.7,70,,1971.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,674,3000,
I&D ABSCESS/CARB/FAR COMPLICATED,6101589,CDM,360,RC,10061,HCPCS,OUTPATIENT,,,698.00,279.20,,3000,100,,,case rate,pays based on per visit rate,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.8,60,,335.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,270.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,488.6,70,,390.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,3000,
NEUROPLASTY/TRANS POS ULNAR NERVE ELBOW,6101590,CDM,360,RC,64718,HCPCS,OUTPATIENT,,,3616.00,1446.40,,3000,100,,,case rate,pays based on per visit rate,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2169.6,60,,1735.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,775.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,3073.6,85,,2458.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,2531.2,70,,2024.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,1157.12,32,,925.7,percent of total billed charges,32% of total billed charges,419,3073.6,
REP COMPLEX TRNK 2.6-7.5CM,6101591,CDM,360,RC,13101,HCPCS,OUTPATIENT,,,1096.00,438.40,,3000,100,,,case rate,pays based on per visit rate,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,657.6,60,,526.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,501.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,931.6,85,,745.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,767.2,70,,613.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,3000,
REP COMPLEX TRNK EA ADDNL 5 CM,6101592,CDM,360,RC,13102,HCPCS,OUTPATIENT,,,150.00,60.00,,3000,100,,,case rate,pays based on per visit rate,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,3000,
"EXC TMR, SFT TISS, BACK/FLANK SF 5CM & >",6101593,CDM,360,RC,21933,HCPCS,OUTPATIENT,,,5220.00,2088.00,,3000,100,,,case rate,pays based on per visit rate,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3132,60,,2505.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,979.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,4437,85,,3549.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,3654,70,,2923.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,1670.4,32,,1336.32,percent of total billed charges,32% of total billed charges,979.99,4437,
"MASTECTOMY, PARTIAL W/LYMPH ADENECTOMY",6101594,CDM,360,RC,19302,HCPCS,OUTPATIENT,,,13407.00,5362.80,,3000,100,,,case rate,pays based on per visit rate,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,8044.2,60,,6435.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1212.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,11395.95,85,,9116.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,9384.9,70,,7507.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,4290.24,32,,3432.19,percent of total billed charges,32% of total billed charges,935,11395.95,
OPN TX  FX WB SUR DIST TIBIA AND FIBULA,6101595,CDM,360,RC,27828,HCPCS,OUTPATIENT,,,29836.00,11934.40,,3000,100,,,case rate,pays based on per visit rate,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,17901.6,60,,14321.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1736.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,25360.6,85,,20288.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,20885.2,70,,16708.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,591,25360.6,
FIBULA NAIL 3.8X130MM AR-8973R-38-130,6101596,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,11767.25,4706.90,,4706.9,40,,,percent of total billed charges,40% of total billed charges,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7060.35,60,,5648.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,10002.16,85,,8001.73,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,8237.08,70,,6589.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,3765.52,32,,3012.42,percent of total billed charges,32% of total billed charges,3765.52,10002.16,
TOTAL HIP ARTHROPLASTY,6101597,CDM,360,RC,27130,HCPCS,OUTPATIENT,,,29836.00,11934.40,,3000,100,,,case rate,pays based on per visit rate,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17901.6,60,,14321.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1682.09,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,25360.6,85,,20288.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,20885.2,70,,16708.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,1682.09,25360.6,
"ASP HYDROCELE, TUNICA VAGINALIS W/WO MED",6101598,CDM,360,RC,55000,HCPCS,OUTPATIENT,,,1507.00,602.80,,3000,100,,,case rate,pays based on per visit rate,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,904.2,60,,723.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,153.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,1280.95,85,,1024.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,1054.9,70,,843.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,482.24,32,,385.79,percent of total billed charges,32% of total billed charges,153.26,3000,
PINCH GRAFT S/M SMALL ULCER  MIN OPN SP,6101599,CDM,360,RC,15050,HCPCS,OUTPATIENT,,,1408.00,563.20,,3000,100,,,case rate,pays based on per visit rate,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,844.8,60,,675.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,758.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,1196.8,85,,957.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,985.6,70,,788.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,419,3000,
REV TOTAL SHOULDER ARTHTO W/ALLOGRAFT IF,6101600,CDM,360,RC,23474,HCPCS,OUTPATIENT,,,3420.00,1368.00,,3000,100,,,case rate,pays based on per visit rate,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2052,60,,1641.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2279.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,2907,85,,2325.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,2394,70,,1915.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,1094.4,32,,875.52,percent of total billed charges,32% of total billed charges,1094.4,3000,
6101601,6101601,CDM,360,RC,46320,HCPCS,OUTPATIENT,,,2624.00,1049.60,,3000,100,,,case rate,pays based on per visit rate,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1574.4,60,,1259.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,272.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,2230.4,85,,1784.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,272.73,3000,
"OSTECTOMY COMP EXCN, OTHER METATARSAL HE",6101602,CDM,360,RC,28112,HCPCS,OUTPATIENT,,,7212.00,2884.80,,3000,100,,,case rate,pays based on per visit rate,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4327.2,60,,3461.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,604.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,6130.2,85,,4904.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,5048.4,70,,4038.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,479,6130.2,
"ADJ TISS TRANSFER OR REARRANGEMENT, FORE",6101604,CDM,360,RC,14040,HCPCS,OUTPATIENT,,,4181.00,1672.40,,3000,100,,,case rate,pays based on per visit rate,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2508.6,60,,2006.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,952.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,3553.85,85,,2843.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,2926.7,70,,2341.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,419,3553.85,
BIOPSY/EXCISION LYMPH NODE(S); OPEN SUPE,6101605,CDM,360,RC,38500,HCPCS,OUTPATIENT,,,8330.00,3332.00,,3000,100,,,case rate,pays based on per visit rate,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4998,60,,3998.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,440.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,7080.5,85,,5664.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,5831,70,,4664.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,2665.6,32,,2132.48,percent of total billed charges,32% of total billed charges,419,7080.5,
ADJ TISS TRANSFER/REARRANGE/ANY ARE;EA A,6101606,CDM,360,RC,14302,HCPCS,OUTPATIENT,,,3941.00,1576.40,,3000,100,,,case rate,pays based on per visit rate,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2364.6,60,,1891.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,281.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,3349.85,85,,2679.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,2758.7,70,,2206.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,1261.12,32,,1008.9,percent of total billed charges,32% of total billed charges,281.31,3349.85,
GASTRO W/GASTRO TUBE,6143246,CDM,750,RC,43246,HCPCS,OUTPATIENT,,,3205.00,1282.00,,3000,100,,,case rate,pays based on per visit rate,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1923,60,,1538.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,258.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2724.25,85,,2179.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2243.5,70,,1794.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,258.98,3000,
COLONOSCOPY DISCONTINUED,6145378,CDM,750,RC,45378,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,436.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,3000,
SUTURE J270H,6200101,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE 904H,6200103,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
GRIPPER NEEDLE  21-2717-24,6200105,CDM,272,RC,,,OUTPATIENT,,,25.22,10.09,,,,,,other ,not seperately reimbursable,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.13,60,,12.1,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,21.44,85,,17.15,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,17.65,70,,14.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,8.07,32,,6.46,percent of total billed charges,32% of total billed charges,8.07,21.44,
CUTTING LOOP 3.5MM,6200107,CDM,272,RC,,,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,141.95,
DRAPE C-SECTION,6200108,CDM,272,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
J TUBE,6200112,CDM,272,RC,,,OUTPATIENT,,,671.00,268.40,,,,,,other ,not seperately reimbursable,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,402.6,60,,322.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,570.35,85,,456.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,469.7,70,,375.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,214.72,32,,171.78,percent of total billed charges,32% of total billed charges,214.72,570.35,
PLUME FILTERATION DEVICE,6200115,CDM,272,RC,,,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
CROSS BLADE 3.5,6200116,CDM,272,RC,,,OUTPATIENT,,,228.00,91.20,,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.8,60,,109.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,159.6,70,,127.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,193.8,
CROSS BLADE 3.5,6200117,CDM,272,RC,,,OUTPATIENT,,,228.00,91.20,,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.8,60,,109.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,159.6,70,,127.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,193.8,
CROSS BLADE,6200119,CDM,272,RC,,,OUTPATIENT,,,228.00,91.20,,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.8,60,,109.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,159.6,70,,127.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,32,,58.37,percent of total billed charges,32% of total billed charges,72.96,193.8,
BURR OVAL,6200120,CDM,272,RC,,,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
SUTURE J905T,6200129,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SUTURE J259H,6200130,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE Y497G,6200138,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SUTURE Y496G,6200139,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
HOLDER-NASAL DRESSING,6200141,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SUTURE RSB-5,6200146,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
ENT-INSULATED/IMA BLADE ELECTRODE,6200149,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SUTURE PDS,6200150,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SUTURE J206G,6200151,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DURA PREP,6200159,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
GIA 80 TCT75,6200160,CDM,272,RC,,,OUTPATIENT,,,438.00,175.20,,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.8,60,,210.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,372.3,
GIA 80 RELOAD TRT75,6200161,CDM,272,RC,,,OUTPATIENT,,,218.00,87.20,,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.8,60,,104.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,152.6,70,,122.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,32,,55.81,percent of total billed charges,32% of total billed charges,69.76,185.3,
ROT 55 GR AX55G,6200166,CDM,272,RC,,,OUTPATIENT,,,625.00,250.00,,,,,,other ,not seperately reimbursable,200,32,,160,percent of total billed charges,32% of total billed charges,200,32,,160,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,375,60,,300,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200,32,,160,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200,32,,160,percent of total billed charges,32% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200,32,,160,percent of total billed charges,32% of total billed charges,200,32,,160,percent of total billed charges,32% of total billed charges,437.5,70,,350,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,200,32,,160,percent of total billed charges,32% of total billed charges,200,32,,160,percent of total billed charges,32% of total billed charges,200,531.25,
CAMERA COVER-STERILE,6200168,CDM,272,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
BURR 7032-6504,6200181,CDM,272,RC,,,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
BUR 7032-6506,6200182,CDM,272,RC,,,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
BURR 7032-6542,6200185,CDM,272,RC,,,OUTPATIENT,,,115.00,46.00,,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,97.75,
BURR 7032-6543,6200186,CDM,272,RC,,,OUTPATIENT,,,115.00,46.00,,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,97.75,
NEEDLE ELECTRODE,6200187,CDM,272,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
NEEDLE ELECTRODE,6200188,CDM,272,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
HEALICOIL,6200194,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1117.00,446.80,,,,,,other ,not seperately reimbursable,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,670.2,60,,536.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,949.45,85,,759.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,781.9,70,,625.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,357.44,32,,285.95,percent of total billed charges,32% of total billed charges,357.44,949.45,
AMBIENT SUPER TURBOVAC,6200195,CDM,272,RC,,,OUTPATIENT,,,619.00,247.60,,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.4,60,,297.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,526.15,85,,420.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,433.3,70,,346.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,526.15,
DISP FIRST PASS STR PASSR,6200196,CDM,272,RC,,,OUTPATIENT,,,482.00,192.80,,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.2,60,,231.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,409.7,85,,327.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,337.4,70,,269.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,32,,123.39,percent of total billed charges,32% of total billed charges,154.24,409.7,
STRYKER BLADE,6200655,CDM,272,RC,,,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
STRYKER BLADES MED,6200664,CDM,272,RC,,,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,79.9,
SYSTEM ENDOSUTURE,6201333,CDM,272,RC,,,OUTPATIENT,,,491.00,196.40,,,,,,other ,not seperately reimbursable,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.6,60,,235.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,417.35,85,,333.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,343.7,70,,274.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,157.12,32,,125.7,percent of total billed charges,32% of total billed charges,157.12,417.35,
ENDO SUT RELOAD,6201334,CDM,272,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
LACTATED RINGERS IRRIG 5000,6201364,CDM,250,RC,J7120,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
BRANCH ADAPTER,6201366,CDM,271,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
SUTURE TI-CRON SZ@30,6201367,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
FORCEPS BX-ENDO,6201368,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
CLIP APPLIER ROTATE SHAFT,6201369,CDM,272,RC,,,OUTPATIENT,,,258.00,103.20,,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.8,60,,123.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,180.6,70,,144.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,219.3,
FORCEPS PEDIATRIC,6201370,CDM,272,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
TWISTER,6201371,CDM,272,RC,,,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
OBTRYX SYSTEM HALO,6201372,CDM,272,RC,,,OUTPATIENT,,,3314.00,1325.60,,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1988.4,60,,1590.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,2816.9,85,,2253.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,2319.8,70,,1855.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,32,,848.38,percent of total billed charges,32% of total billed charges,1060.48,2816.9,
FORCEPS SNARE ROTATABLE,6201373,CDM,272,RC,,,OUTPATIENT,,,137.00,54.80,,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,116.45,
USE #6243147,6201374,CDM,272,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
ELECTRODE BALL,6201385,CDM,272,RC,,,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
EVAVUATION SMOKE E3590,6201386,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
STAPLER ENDO 45B ATS45,6201388,CDM,272,RC,,,OUTPATIENT,,,849.00,339.60,,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,509.4,60,,407.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,721.65,85,,577.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,594.3,70,,475.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,721.65,
DILATOR INSUFFLATION SYSTEM,6201391,CDM,272,RC,,,OUTPATIENT,,,108.00,43.20,,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,60,,51.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,75.6,70,,60.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,91.8,
TWISTER,6201392,CDM,272,RC,,,OUTPATIENT,,,281.00,112.40,,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.6,60,,134.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,89.92,238.85,
POLYPECTOMY SNARES,6203344,CDM,271,RC,,,OUTPATIENT,,,71.50,28.60,,,,,,other ,not seperately reimbursable,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.9,60,,34.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,60.78,85,,48.62,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,50.05,70,,40.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,22.88,32,,18.3,percent of total billed charges,32% of total billed charges,22.88,60.78,
SUTURE J358H,6203346,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J232H,6203349,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J344H,6203350,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DUAL MESH 26X34,6204492,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,6135.00,2454.00,,2454,40,,,percent of total billed charges,40% of total billed charges,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3681,60,,2944.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,5214.75,85,,4171.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,4294.5,70,,3435.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,1963.2,32,,1570.56,percent of total billed charges,32% of total billed charges,1963.2,5214.75,
ANCHOR TISSUE/BONE,6205976,CDM,360,RC,C1713,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
SCLERA TISSUE FULL SIZE,6205977,CDM,272,RC,,,OUTPATIENT,,,1875.00,750.00,,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,600,32,,480,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1125,60,,900,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,1593.75,85,,1275,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,600,32,,480,percent of total billed charges,32% of total billed charges,1312.5,70,,1050,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,600,32,,480,percent of total billed charges,32% of total billed charges,600,1593.75,
SCLERA TISSUE 1/4 SIZE,6205979,CDM,272,RC,,,OUTPATIENT,,,940.00,376.00,,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564,60,,451.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,799,85,,639.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,658,70,,526.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,799,
NERVE CHANNEL CONNECTOR,6208899,CDM,272,RC,,,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,98.6,
NERVE ELECTRODE,6208910,CDM,272,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
TUBE JEJUNAL FEEDING,6209643,CDM,272,RC,B4087,HCPCS,OUTPATIENT,,,427.00,170.80,,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256.2,60,,204.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,298.9,70,,239.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,44.99,362.95,
OR 30 MINUTES,6210013,CDM,360,RC,,,OUTPATIENT,,,3000.00,1200.00,,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1800,60,,1440,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,2550,85,,2040,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,2100,70,,1680,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,960,2550,
MESH PHSL,6210014,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1347.00,538.80,,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,808.2,60,,646.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,942.9,70,,754.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,1144.95,
MESH PHSM,6210015,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1573.00,629.20,,,,,,other ,not seperately reimbursable,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,943.8,60,,755.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,1337.05,85,,1069.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,1101.1,70,,880.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,503.36,32,,402.69,percent of total billed charges,32% of total billed charges,503.36,1337.05,
SUCTION COAGULATOR,6210017,CDM,272,RC,,,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,98.6,
SAME AS #610057,6210019,CDM,272,RC,,,OUTPATIENT,,,963.00,385.20,,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,577.8,60,,462.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,818.55,85,,654.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,674.1,70,,539.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,32,,246.53,percent of total billed charges,32% of total billed charges,308.16,818.55,
OR 31-60 MINUTESM,6210021,CDM,360,RC,,,OUTPATIENT,,,2500.00,1000.00,,,,,,other ,not seperately reimbursable,800,32,,640,percent of total billed charges,32% of total billed charges,800,32,,640,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1500,60,,1200,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,32,,640,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,32,,640,percent of total billed charges,32% of total billed charges,2125,85,,1700,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,32,,640,percent of total billed charges,32% of total billed charges,800,32,,640,percent of total billed charges,32% of total billed charges,1750,70,,1400,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,800,32,,640,percent of total billed charges,32% of total billed charges,800,32,,640,percent of total billed charges,32% of total billed charges,800,2125,
EACH ADDIITONAL 30 MINUTES,6210039,CDM,360,RC,,,OUTPATIENT,,,2000.00,800.00,,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1200,60,,960,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,1700,85,,1360,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,1400,70,,1120,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,640,1700,
OR 91-120 MINUTES,6210047,CDM,360,RC,,,OUTPATIENT,,,3000.00,1200.00,,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1800,60,,1440,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,2550,85,,2040,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,2100,70,,1680,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,960,2550,
OR ADDL' 30 MINUTES,6210054,CDM,360,RC,,,OUTPATIENT,,,377.00,150.80,,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.2,60,,180.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,263.9,70,,211.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,320.45,
CATH HICKMAN,6210056,CDM,272,RC,,,OUTPATIENT,,,1100.00,440.00,,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,660,60,,528,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,770,70,,616,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,935,
BEVELED TUBE,6210058,CDM,272,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
COLLAR VENT TUBE,6210059,CDM,272,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
PACEMAKER-BATTERY,6210070,CDM,272,RC,,,OUTPATIENT,,,8436.00,3374.40,,,,,,other ,not seperately reimbursable,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5061.6,60,,4049.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,7170.6,85,,5736.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,5905.2,70,,4724.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,2699.52,32,,2159.62,percent of total billed charges,32% of total billed charges,2699.52,7170.6,
AMS 30 MINUTES,6210075,CDM,490,RC,,,OUTPATIENT,,,1875.00,750.00,,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,600,32,,480,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1125,60,,900,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,1593.75,85,,1275,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,600,32,,480,percent of total billed charges,32% of total billed charges,1312.5,70,,1050,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,600,32,,480,percent of total billed charges,32% of total billed charges,600,32,,480,percent of total billed charges,32% of total billed charges,600,1593.75,
AMS 31-60 MINUTES,6210077,CDM,490,RC,,,OUTPATIENT,,,2251.00,900.40,,,,,,other ,not seperately reimbursable,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1350.6,60,,1080.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,1913.35,85,,1530.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,1575.7,70,,1260.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,720.32,32,,576.26,percent of total billed charges,32% of total billed charges,720.32,1913.35,
BONEGRAFT,6210078,CDM,278,RC,,,OUTPATIENT,,,1620.00,648.00,,,,,,other ,not seperately reimbursable,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,972,60,,777.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,1377,85,,1101.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,1134,70,,907.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,518.4,32,,414.72,percent of total billed charges,32% of total billed charges,518.4,1377,
AMS 61-90 MINUTES,6210080,CDM,490,RC,,,OUTPATIENT,,,2627.00,1050.80,,,,,,other ,not seperately reimbursable,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1576.2,60,,1260.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,2232.95,85,,1786.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,1838.9,70,,1471.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,840.64,32,,672.51,percent of total billed charges,32% of total billed charges,840.64,2232.95,
AMS 91-120 MINUTES,6210088,CDM,490,RC,,,OUTPATIENT,,,3000.00,1200.00,,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1800,60,,1440,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,2550,85,,2040,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,2100,70,,1680,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,960,32,,768,percent of total billed charges,32% of total billed charges,960,32,,768,percent of total billed charges,32% of total billed charges,960,2550,
AMS ADD'L 30 MINUTES,6210090,CDM,490,RC,,,OUTPATIENT,,,377.00,150.80,,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.2,60,,180.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,263.9,70,,211.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,320.45,
OTHER RECOVERY-AMS,6210095,CDM,710,RC,,,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
CYTOLOGY-PAP SMEAR,6210104,CDM,310,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
SUTURE 1755G,6210135,CDM,272,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
SUTURE VP-832,6210143,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SUTURE 8976H,6210145,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
SUTURE 8617G,6210146,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
SUTURE 8618G,6210147,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
SUTURE 8634G,6210148,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SUTURE 8632G,6210149,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
SUTURE 8687H,6210150,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SUTURE 8434H,6210151,CDM,272,RC,,,OUTPATIENT,,,7.50,3.00,,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.5,60,,3.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,6.38,85,,5.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,5.25,70,,4.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,6.38,
SUTURE 8455H,6210152,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE 8807H,6210153,CDM,272,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
SUTURE K802H,6210156,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SUTURE Y266H,6210157,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NANOSCOPE HANDPIECE (AR-3210-0040),6210158,CDM,272,RC,,,OUTPATIENT,,,2590.50,1036.20,,,,,,other ,not seperately reimbursable,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1554.3,60,,1243.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,2201.93,85,,1761.54,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,1813.35,70,,1450.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,828.96,32,,663.17,percent of total billed charges,32% of total billed charges,828.96,2201.93,
NANOSCOPE OPERATIVE SHEATH KIT (AR-32,6210159,CDM,272,RC,,,OUTPATIENT,,,261.25,104.50,,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.75,60,,125.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,222.06,85,,177.65,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,182.88,70,,146.3,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,222.06,
DISSECTOR SJ 3.0MM (AR-7300DS),6210160,CDM,272,RC,,,OUTPATIENT,,,261.25,104.50,,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.75,60,,125.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,222.06,85,,177.65,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,182.88,70,,146.3,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,32,,66.88,percent of total billed charges,32% of total billed charges,83.6,222.06,
AMBU BAG CHILD,6210298,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
CORD-BIPOLAR,6210375,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
SINUS PACK,6210567,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
CATH SUCT14FR LTX FREE,6210598,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LUKENS TRAP,6211212,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ULTRA FAST CRVD,6211213,CDM,272,RC,,,OUTPATIENT,,,982.00,392.80,,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,589.2,60,,471.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,392.8,40,,314.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,834.7,85,,667.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,687.4,70,,549.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,834.7,
ULTRA FAST STRT,6211214,CDM,272,RC,,,OUTPATIENT,,,982.00,392.80,,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,589.2,60,,471.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,392.8,40,,314.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,834.7,85,,667.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,687.4,70,,549.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,32,,251.39,percent of total billed charges,32% of total billed charges,314.24,834.7,
ULTRA FAST CUTT STRT,6211215,CDM,272,RC,,,OUTPATIENT,,,371.00,148.40,,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.6,60,,178.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,148.4,40,,118.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,259.7,70,,207.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,315.35,
T TUBES,6213546,CDM,272,RC,,,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
DRAIN 10 FLAT,6213611,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
ORTHO BOOT-SHORT LEG,6213612,CDM,271,RC,,,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,49.6,40,,39.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,105.4,
DRAIN TOE,6213615,CDM,272,RC,,,OUTPATIENT,,,205.00,82.00,,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123,60,,98.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82,40,,65.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,143.5,70,,114.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,174.25,
STOCKINETTE LARGE,6214421,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
MYRINGOTOMY KNIFE LANCET/MASNGTOMY,6214555,CDM,272,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
ROUND CUTTING BURR,6214557,CDM,272,RC,,,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,113.9,
DIAMOND BURR 5MM X 65MM,6214558,CDM,272,RC,,,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
ROUND BURR 5 0MM,6214559,CDM,272,RC,,,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
DIAMOND BURR 4MM X 65MM,6214562,CDM,272,RC,,,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
ROUND BURR 3MM X 70MM,6214563,CDM,272,RC,,,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
DRAIN BULB,6214924,CDM,272,RC,,,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,52.8,40,,42.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
DRAIN 10 ROUND,6214925,CDM,272,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
INS ANT SEG DRAIN DEV EXT APPROACH,6214926,CDM,360,RC,66183,HCPCS,OUTPATIENT,,,7650.00,3060.00,,3000,100,,,case rate,pays based on per visit rate,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4590,60,,3672,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1267.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,6502.5,85,,5202,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,5355,70,,4284,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,1267.35,6502.5,
INS ANT SEG DRAIN DEV INT APPROACH,6214927,CDM,360,RC,0671T,HCPCS,OUTPATIENT,,,7650.00,3060.00,,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4590,60,,3672,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,6502.5,85,,5202,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,5355,70,,4284,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,2448,32,,1958.4,percent of total billed charges,32% of total billed charges,2448,6502.5,
SUPRAFOIL IMPLANT,6215093,CDM,272,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
BANDAGE 3  LF,6215096,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
BANDAGE ESMARK 4  STER,6215098,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DERMATONE BLADE  (BROWN),6215301,CDM,272,RC,,,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,113.9,
BLADE GIGLE SAW,6215384,CDM,272,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
PEANUT DISSECTORS,6215471,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TRANS-URE,6215474,CDM,272,RC,,,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,107.1,
DERMA CARRIER EXPANSION,6215475,CDM,272,RC,,,OUTPATIENT,,,101.00,40.40,,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,85.85,
BALDES-SAGITAL SAW,6215500,CDM,272,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
EAR BLADES,6215525,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
HEMOVAC S,6215681,CDM,272,RC,,,OUTPATIENT,,,26.60,10.64,,,,,,other ,not seperately reimbursable,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.96,60,,12.77,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,22.61,85,,18.09,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,18.62,70,,14.9,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,8.51,32,,6.81,percent of total billed charges,32% of total billed charges,8.51,22.61,
HEMOVAC M,6215682,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
HEMOVAC L,6215683,CDM,272,RC,,,OUTPATIENT,,,286.00,114.40,,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.6,60,,137.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,200.2,70,,160.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,32,,73.22,percent of total billed charges,32% of total billed charges,91.52,243.1,
HEMOVAC XL,6215684,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
K WIRES .035X9,6216000,CDM,278,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
LIGACLIP LT100,6217350,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LIGACLIP LT300,6217351,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SPONGE LAP 18X18 STER,6217893,CDM,272,RC,,,OUTPATIENT,,,6.50,2.60,,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.9,60,,3.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,5.53,85,,4.42,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,4.55,70,,3.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,5.53,
TRU CUT NEEDLE,6217919,CDM,272,RC,,,OUTPATIENT,,,413.00,165.20,,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.8,60,,198.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,351.05,85,,280.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,289.1,70,,231.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,32,,105.73,percent of total billed charges,32% of total billed charges,132.16,351.05,
CELERO 12-GAUGE INTRODUCER,6217920,CDM,272,RC,,,OUTPATIENT,,,248.00,99.20,,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,60,,119.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,210.8,85,,168.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,173.6,70,,138.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,32,,63.49,percent of total billed charges,32% of total billed charges,79.36,210.8,
TUMARK PROFESSIONAL Q SHAPE 12CM,6217921,CDM,272,RC,,,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
BILE BAG,6218230,CDM,272,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
SPONGE XRAY 4X4 ST,6218579,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SYRINGE ASEPTO DISPOSABLE,6218586,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BOVIE DISP HANDSAW PENCIL/PENCIL CORD,6218628,CDM,272,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
SUCTION COAGULATOR,6218629,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
BOVIE INFANT ELECTRODE,6218630,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
ENDOLOOP EZLOG,6218702,CDM,272,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
TIPS OF SCISSORS,6218834,CDM,272,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
YAG CAPSULOTOMY,6218875,CDM,361,RC,66821,HCPCS,OUTPATIENT,,,1096.00,438.40,,3000,100,,,case rate,pays based on per visit rate,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,657.6,60,,526.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,410.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,931.6,85,,745.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,767.2,70,,613.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,3000,
YAG IRRIDECTOMY,6218883,CDM,360,RC,66761,HCPCS,OUTPATIENT,,,1096.00,438.40,,3000,100,,,case rate,pays based on per visit rate,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,657.6,60,,526.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,369.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,931.6,85,,745.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,767.2,70,,613.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,3000,
SGY REC RM 30 MIN,6220004,CDM,710,RC,,,OUTPATIENT,,,471.00,188.40,,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.6,60,,226.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,329.7,70,,263.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,400.35,
SGY REC RM 31 90 MIN,6220012,CDM,710,RC,,,OUTPATIENT,,,706.00,282.40,,,,,,other ,not seperately reimbursable,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423.6,60,,338.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,600.1,85,,480.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,494.2,70,,395.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,225.92,32,,180.74,percent of total billed charges,32% of total billed charges,225.92,600.1,
SGY REC RM ADDTL HR,6220020,CDM,710,RC,,,OUTPATIENT,,,237.00,94.80,,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.2,60,,113.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,165.9,70,,132.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,201.45,
"SGY REC PHASE II, Per 30 MIN",6220021,CDM,710,RC,,,OUTPATIENT,,,237.00,94.80,,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.2,60,,113.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,165.9,70,,132.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,32,,60.67,percent of total billed charges,32% of total billed charges,75.84,201.45,
OBS REC RM 31 90 MIN,6220038,CDM,710,RC,,,OUTPATIENT,,,555.00,222.00,,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,471.75,
OBS REC RM ADDTL HR,6220046,CDM,710,RC,,,OUTPATIENT,,,180.00,72.00,,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108,60,,86.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,126,70,,100.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,153,
OBS REC RM 30 MIN,6220053,CDM,710,RC,,,OUTPATIENT,,,524.00,209.60,,,,,,other ,not seperately reimbursable,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.4,60,,251.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,366.8,70,,293.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,167.68,32,,134.14,percent of total billed charges,32% of total billed charges,167.68,445.4,
NEURO-PATTIES 1X3 COTTON,6220057,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
SGY REC RM 91 120 MIN,6220061,CDM,710,RC,,,OUTPATIENT,,,940.00,376.00,,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564,60,,451.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,799,85,,639.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,658,70,,526.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,32,,240.64,percent of total billed charges,32% of total billed charges,300.8,799,
OBS REC RM 91 120 MIN,6220079,CDM,710,RC,,,OUTPATIENT,,,595.00,238.00,,,,,,other ,not seperately reimbursable,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357,60,,285.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,505.75,85,,404.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,416.5,70,,333.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,190.4,32,,152.32,percent of total billed charges,32% of total billed charges,190.4,505.75,
SUTURE A185H,6220146,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE A-185H,6220147,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE K832H,6220149,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE 685G,6220150,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE 624H,6220152,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PAD DISCARD A PAD 30 COUNT (SHARPS),6230094,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BRONCH W/BIOPSY & WASHING,6231622,CDM,360,RC,31622,HCPCS,OUTPATIENT,,,1673.00,669.20,,3000,100,,,case rate,pays based on per visit rate,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1003.8,60,,803.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,312,3000,
ENDO W/BRONC ALEVOLAR BRUSHING,6231624,CDM,360,RC,31624,HCPCS,OUTPATIENT,,,1673.00,669.20,,3000,100,,,case rate,pays based on per visit rate,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1003.8,60,,803.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,323.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,323.83,3000,
ENDO W/BRONCBIOPSY(S),6231625,CDM,360,RC,31625,HCPCS,OUTPATIENT,,,1673.00,669.20,,3000,100,,,case rate,pays based on per visit rate,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1003.8,60,,803.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,446.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,419,3000,
ENDO W/TRANSBRONC LUNG BIOPSY(S),6231628,CDM,360,RC,31628,HCPCS,OUTPATIENT,,,1673.00,669.20,,3000,100,,,case rate,pays based on per visit rate,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1003.8,60,,803.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,474.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1422.05,85,,1137.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,535.36,32,,428.29,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY W THER ASPIRATION OF TRACH,6231645,CDM,360,RC,31645,HCPCS,OUTPATIENT,,,465.00,186.00,,3000,100,,,case rate,pays based on per visit rate,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,279,60,,223.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,346.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,325.5,70,,260.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,3000,
PCEEA 31 MM CDH33,6240100,CDM,272,RC,,,OUTPATIENT,,,905.00,362.00,,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543,60,,434.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,769.25,85,,615.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,633.5,70,,506.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,289.6,769.25,
SURGICEL ENDO,6240402,CDM,272,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
BARD MESH LRG,6240689,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1200.00,480.00,,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,1020,
BARD MESH MED,6240690,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,821.00,328.40,,,,,,other ,not seperately reimbursable,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492.6,60,,394.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,697.85,85,,558.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,574.7,70,,459.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,262.72,32,,210.18,percent of total billed charges,32% of total billed charges,262.72,697.85,
BARD MESH SML,6240691,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1600.00,640.00,,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,60,,768,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,1360,85,,1088,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,1120,70,,896,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,1360,
"K-LESS T-ROPE W/DRV, SYN REPR",6240692,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,5874.00,2349.60,,2349.6,40,,,percent of total billed charges,40% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3524.4,60,,2819.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,4992.9,85,,3994.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,32,,1503.74,percent of total billed charges,32% of total billed charges,1879.68,4992.9,
TROCAR CTB03,6240985,CDM,272,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
TROCAR C0R47,6240987,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
TROCAR CTB33,6240988,CDM,272,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
DR. NELSONS KIT,6240989,CDM,272,RC,,,OUTPATIENT,,,760.00,304.00,,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456,60,,364.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,646,85,,516.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,532,70,,425.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,646,
MFGIA 60 DLU TCR55,6240991,CDM,272,RC,,,OUTPATIENT,,,162.00,64.80,,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.2,60,,77.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,113.4,70,,90.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,137.7,
MFP TA30 TL30,6240992,CDM,272,RC,,,OUTPATIENT,,,272.00,108.80,,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,60,,130.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,190.4,70,,152.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,231.2,
MFP TA30 DLU TR30,6240993,CDM,272,RC,,,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,126.65,
PREMIUM MF TA* 60-3.5 TIT STAPLER,6240994,CDM,272,RC,,,OUTPATIENT,,,301.00,120.40,,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.6,60,,144.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,210.7,70,,168.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,255.85,
MFP TA60 DLU TR60,6240995,CDM,272,RC,,,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
STAPLER 90MM TL90,6240996,CDM,272,RC,,,OUTPATIENT,,,626.00,250.40,,,,,,other ,not seperately reimbursable,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,375.6,60,,300.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,532.1,85,,425.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,438.2,70,,350.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,200.32,32,,160.26,percent of total billed charges,32% of total billed charges,200.32,532.1,
MFP TA90 DLU TR90,6240997,CDM,272,RC,,,OUTPATIENT,,,330.00,132.00,,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,60,,158.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,231,70,,184.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,32,,84.48,percent of total billed charges,32% of total billed charges,105.6,280.5,
PCEEA 28 MM CDH29,6240998,CDM,272,RC,,,OUTPATIENT,,,800.00,320.00,,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,60,,384,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,560,70,,448,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,680,
DR. MOORES KIT,6240999,CDM,272,RC,,,OUTPATIENT,,,759.00,303.60,,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455.4,60,,364.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,645.15,
BRONCHOSCOPY DIAGNOSTIC,6243139,CDM,750,RC,31622,HCPCS,OUTPATIENT,,,3039.00,1215.60,,3000,100,,,case rate,pays based on per visit rate,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1823.4,60,,1458.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,2583.15,85,,2066.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,2127.3,70,,1701.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,312,3000,
BRUSH CYTOLOGY DISP,6243147,CDM,272,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
COLONOSCOPY DIAG,6243154,CDM,750,RC,45378,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,436.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,3000,
COLONOSCOPY SCREENING,6243155,CDM,750,RC,45378,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,436.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,3000,
COLONSCOPY DIAGNOSTIC,6243156,CDM,750,RC,45378,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,436.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY DIA,6243162,CDM,750,RC,43235,HCPCS,OUTPATIENT,,,1669.00,667.60,,3000,100,,,case rate,pays based on per visit rate,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1001.4,60,,801.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,380.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1168.3,70,,934.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,312,3000,
SIGMOIDOSCOPY,6243196,CDM,750,RC,45330,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,234.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,234.88,3000,
GELFOAM SIZE 100,6243220,CDM,272,RC,,,OUTPATIENT,,,101.00,40.40,,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,85.85,
GASTRO PRIMARY EXAM,6243234,CDM,750,RC,43235,HCPCS,OUTPATIENT,,,1669.00,667.60,,3000,100,,,case rate,pays based on per visit rate,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1001.4,60,,801.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,380.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1168.3,70,,934.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,312,3000,
GASTROSCOPY W/PEG PLACEMENT,6243236,CDM,750,RC,43246,HCPCS,OUTPATIENT,,,3205.00,1282.00,,3000,100,,,case rate,pays based on per visit rate,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1923,60,,1538.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,258.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2724.25,85,,2179.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2243.5,70,,1794.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,258.98,3000,
GASTROSCOPY W/BX,6243239,CDM,750,RC,43239,HCPCS,OUTPATIENT,,,2000.00,800.00,,3000,100,,,case rate,pays based on per visit rate,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1200,60,,960,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,484.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,1700,85,,1360,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,1400,70,,1120,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,640,32,,512,percent of total billed charges,32% of total billed charges,640,32,,512,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY W/BAND LIGATION,6243244,CDM,750,RC,43244,HCPCS,OUTPATIENT,,,1781.00,712.40,,3000,100,,,case rate,pays based on per visit rate,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1068.6,60,,854.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1513.85,85,,1211.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1246.7,70,,997.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,312.53,3000,
GASTROSCOPY W/DILATION,6243245,CDM,750,RC,43245,HCPCS,OUTPATIENT,,,3205.00,1282.00,,3000,100,,,case rate,pays based on per visit rate,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1923,60,,1538.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,768.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2724.25,85,,2179.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2243.5,70,,1794.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY W/FB REMOVAL,6243247,CDM,750,RC,43247,HCPCS,OUTPATIENT,,,1669.00,667.60,,3000,100,,,case rate,pays based on per visit rate,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1001.4,60,,801.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,493.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1168.3,70,,934.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY W/INSERT WIRE W/ DILATION,6243248,CDM,750,RC,43248,HCPCS,OUTPATIENT,,,1178.00,471.20,,3000,100,,,case rate,pays based on per visit rate,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,706.8,60,,565.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,531.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,1001.3,85,,801.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,824.6,70,,659.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,376.96,32,,301.57,percent of total billed charges,32% of total billed charges,376.96,3000,
GASTROSCOPY W/BALLOON  DILATION,6243249,CDM,750,RC,43249,HCPCS,OUTPATIENT,,,3205.00,1282.00,,3000,100,,,case rate,pays based on per visit rate,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1923,60,,1538.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1399.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2724.25,85,,2179.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2243.5,70,,1794.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY W/REMOV OF LESIONS W/HOT,6243250,CDM,750,RC,43250,HCPCS,OUTPATIENT,,,1781.00,712.40,,3000,100,,,case rate,pays based on per visit rate,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1068.6,60,,854.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,584.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1513.85,85,,1211.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1246.7,70,,997.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY W/REMOV OF LESIONS W/SNARE,6243251,CDM,750,RC,43251,HCPCS,OUTPATIENT,,,1781.00,712.40,,3000,100,,,case rate,pays based on per visit rate,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1068.6,60,,854.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,639.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1513.85,85,,1211.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1246.7,70,,997.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,419,3000,
GASTROSCOPY W/CONTROL OF BLEEDING,6243255,CDM,750,RC,43255,HCPCS,OUTPATIENT,,,1781.00,712.40,,3000,100,,,case rate,pays based on per visit rate,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1068.6,60,,854.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,809.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1513.85,85,,1211.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,1246.7,70,,997.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,569.92,32,,455.94,percent of total billed charges,32% of total billed charges,419,3000,
GASTR W ESOPHGL DILATATION EGD W/ESOP DI,6243264,CDM,750,RC,43249,HCPCS,OUTPATIENT,,,3205.00,1282.00,,3000,100,,,case rate,pays based on per visit rate,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1923,60,,1538.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1399.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2724.25,85,,2179.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,2243.5,70,,1794.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,1025.6,32,,820.48,percent of total billed charges,32% of total billed charges,419,3000,
DRAIN SUMP TRIPLE ALUM DAVOL,6243295,CDM,272,RC,,,OUTPATIENT,,,174.00,69.60,,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,147.9,
SUTURE  685H,6243337,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CLIPPER BLADE ASSY REMINGTON 3M 9600,6243352,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MARKER SKIN STERILE,6243402,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DOUBLE J STENTS SOFT FLEX 24 CM,6243527,CDM,272,RC,,,OUTPATIENT,,,311.00,124.40,,,,,,other ,not seperately reimbursable,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.6,60,,149.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,217.7,70,,174.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,99.52,32,,79.62,percent of total billed charges,32% of total billed charges,99.52,264.35,
URETERAL CATHETERS,6243550,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
SEPRA PACK-NASAL & SUNUS STINT,6243754,CDM,272,RC,,,OUTPATIENT,,,1896.00,758.40,,,,,,other ,not seperately reimbursable,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1137.6,60,,910.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,1611.6,85,,1289.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,1327.2,70,,1061.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,606.72,32,,485.38,percent of total billed charges,32% of total billed charges,606.72,1611.6,
BANDAGE ESMARK 6,6243790,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
OR OVERTIME CHARGE,6243900,CDM,360,RC,,,OUTPATIENT,,,408.00,163.20,,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,60,,195.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,285.6,70,,228.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,346.8,
VIGILON 4X4,6243942,CDM,272,RC,,,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
ZOMED VENTILATION TUBE,6244111,CDM,272,RC,,,OUTPATIENT,,,98.00,39.20,,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.8,60,,47.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,68.6,70,,54.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,83.3,
PROCTOSIGMOIDOSCOPY RIGID W/WO SPECIM,6245300,CDM,750,RC,45300,HCPCS,OUTPATIENT,,,810.00,324.00,,3000,100,,,case rate,pays based on per visit rate,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486,60,,388.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,162.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,688.5,85,,550.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,567,70,,453.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,162.48,3000,
PROTOSIGMOIDOSCOPY W/DILATION,6245303,CDM,750,RC,45303,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1215.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,3000,
PROCTOSIGMOIDSCOPY W/BX,6245305,CDM,750,RC,45305,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,231.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,231.94,3000,
PROCTORSIGMOIDSCOPY W/REMOVAL FB,6245307,CDM,750,RC,45307,HCPCS,OUTPATIENT,,,2913.00,1165.20,,3000,100,,,case rate,pays based on per visit rate,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1747.8,60,,1398.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,280.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,2476.05,85,,1980.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,2039.1,70,,1631.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,280.08,3000,
PROCTOSIGMOIDOSCOPY W/REMOV LESION W/HOT,6245308,CDM,750,RC,45308,HCPCS,OUTPATIENT,,,5181.00,2072.40,,3000,100,,,case rate,pays based on per visit rate,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3108.6,60,,2486.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,266,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,4403.85,85,,3523.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,3626.7,70,,2901.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,266,4403.85,
PROCTORSIGMOID W/REMOVAL 1 LESION SNARE,6245309,CDM,750,RC,45309,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,274.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,274.2,3000,
PROTOSIGM W/REMOVAL <1 LESION BY SNARE,6245315,CDM,750,RC,45315,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,297.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,297.83,3000,
PROTOSIGMOIDSCOP W/CONTROL OF BLEEDING,6245317,CDM,750,RC,45317,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,282.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,282.95,3000,
PROTOSIGM W/DECOMPRESSION OF VOLVULUS,6245321,CDM,750,RC,45321,HCPCS,OUTPATIENT,,,2913.00,1165.20,,3000,100,,,case rate,pays based on per visit rate,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1747.8,60,,1398.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,137.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,2476.05,85,,1980.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,2039.1,70,,1631.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,932.16,32,,745.73,percent of total billed charges,32% of total billed charges,137.44,3000,
SIGMOIDOSCOPY W/BX,6245331,CDM,750,RC,45331,HCPCS,OUTPATIENT,,,749.00,299.60,,3000,100,,,case rate,pays based on per visit rate,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,449.4,60,,359.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,364.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,636.65,85,,509.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,524.3,70,,419.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,239.68,32,,191.74,percent of total billed charges,32% of total billed charges,239.68,3000,
SIGMOIDOSCOPY W/REMOVAIL OF FB,6245332,CDM,750,RC,45332,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,354.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,3000,
SIGMOIDOSCOPY W/HOT BX REMOVAL,6245333,CDM,750,RC,45333,HCPCS,OUTPATIENT,,,810.00,324.00,,3000,100,,,case rate,pays based on per visit rate,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,486,60,,388.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,421.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,688.5,85,,550.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,567,70,,453.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,3000,
SIGMOIDOSCOPY W/CONTROL BLEEDING,6245334,CDM,750,RC,45334,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,634.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,3000,
PROCTOSIGMOIDSCOPY,6245335,CDM,750,RC,45305,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,231.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,231.94,3000,
SIGMOIDOSCOPY W/REMOVAL LESIONS SNARE,6245338,CDM,750,RC,45338,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,383.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,3000,
SIGMOIDOSCOPY W/REMOVAL LESIONS HOT BX,6245339,CDM,750,RC,45346,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1712.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,3000,
SIGMOIDOSCOPY W/BALLON DILATION,6245340,CDM,750,RC,45340,HCPCS,OUTPATIENT,,,1370.00,548.00,,3000,100,,,case rate,pays based on per visit rate,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,822,60,,657.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,588.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,1164.5,85,,931.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,959,70,,767.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,438.4,32,,350.72,percent of total billed charges,32% of total billed charges,312,3000,
COLONOSCOPY VIA COLOTOMY,6245355,CDM,750,RC,45399,HCPCS,OUTPATIENT,,,1295.00,518.00,,3000,100,,,case rate,pays based on per visit rate,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,777,60,,621.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,1100.75,85,,880.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,906.5,70,,725.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,414.4,32,,331.52,percent of total billed charges,32% of total billed charges,414.4,3000,
COLONOSCOPY ABORTED,6245378,CDM,750,RC,45378,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,436.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,3000,
COLONOSCOPY W/BX COLON,6245380,CDM,750,RC,45380,HCPCS,OUTPATIENT,,,2102.00,840.80,,3000,100,,,case rate,pays based on per visit rate,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1261.2,60,,1008.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,558.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1786.7,85,,1429.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1471.4,70,,1177.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,419,3000,
COLONOSCOPY W/CONTROL OF BLEEDING,6245382,CDM,750,RC,45382,HCPCS,OUTPATIENT,,,2174.00,869.60,,3000,100,,,case rate,pays based on per visit rate,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1304.4,60,,1043.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,860.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,1847.9,85,,1478.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,1521.8,70,,1217.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,419,3000,
COLONOSCOPY W/ABLATION,6245383,CDM,750,RC,45388,HCPCS,OUTPATIENT,,,2174.00,869.60,,3000,100,,,case rate,pays based on per visit rate,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1304.4,60,,1043.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2717.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,1847.9,85,,1478.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,1521.8,70,,1217.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,419,3000,
COLONOSCOPY W/REMOVAL LEISION W/HOT BX,6245384,CDM,750,RC,45384,HCPCS,OUTPATIENT,,,2102.00,840.80,,3000,100,,,case rate,pays based on per visit rate,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1261.2,60,,1008.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,631.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1786.7,85,,1429.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1471.4,70,,1177.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,419,3000,
COLONOSCOPY W/SNARE REMOVAL,6245385,CDM,750,RC,45385,HCPCS,OUTPATIENT,,,2174.00,869.60,,3000,100,,,case rate,pays based on per visit rate,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1304.4,60,,1043.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,585.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,1847.9,85,,1478.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,1521.8,70,,1217.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,695.68,32,,556.54,percent of total billed charges,32% of total billed charges,419,3000,
DILATION OF COLON,6245386,CDM,750,RC,,,OUTPATIENT,,,767.00,306.80,,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.2,60,,368.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,651.95,85,,521.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,536.9,70,,429.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,32,,196.35,percent of total billed charges,32% of total billed charges,245.44,651.95,
COLORECTAL CANCER SCRN SCOPE HI RISK,6245387,CDM,750,RC,G0105,HCPCS,OUTPATIENT,,,1593.00,637.20,,,,,,other ,not seperately reimbursable,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,955.8,60,,764.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,436.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,1354.05,85,,1083.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,1115.1,70,,892.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,509.76,32,,407.81,percent of total billed charges,32% of total billed charges,419,1354.05,
COLORECTAL CANCER SCRN SCOPE LOW RISK,6245388,CDM,750,RC,G0121,HCPCS,OUTPATIENT,,,1594.00,637.60,,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,436.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,419,1354.9,
H2O-FLEX BAG 1000ML,6245891,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ANORECTAL EXAM,6245990,CDM,750,RC,45990,HCPCS,OUTPATIENT,,,2496.00,998.40,,3000,100,,,case rate,pays based on per visit rate,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1497.6,60,,1198.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,137.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,2121.6,85,,1697.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,1747.2,70,,1397.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,137.31,3000,
HEMRRHOID SINGLE TAG,6246220,CDM,272,RC,46220,HCPCS,OUTPATIENT,,,2496.00,998.40,,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1497.6,60,,1198.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,319.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,2121.6,85,,1697.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,1747.2,70,,1397.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,798.72,32,,638.98,percent of total billed charges,32% of total billed charges,312,2121.6,
HEMRRHOIDECTOMY W/BANDING,6246221,CDM,750,RC,46221,HCPCS,OUTPATIENT,,,1594.00,637.60,,3000,100,,,case rate,pays based on per visit rate,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,363.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,363.25,3000,
ANOSCOPY DIAGNOSTIC,6246600,CDM,750,RC,46600,HCPCS,OUTPATIENT,,,236.00,94.40,,3000,100,,,case rate,pays based on per visit rate,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,152.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,3000,
"COLONOSCOPY, DX,  THRU STOMA",6246601,CDM,750,RC,44388,HCPCS,OUTPATIENT,,,1766.00,706.40,,3000,100,,,case rate,pays based on per visit rate,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1059.6,60,,847.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,406.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,1501.1,85,,1200.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,565.12,32,,452.1,percent of total billed charges,32% of total billed charges,312,3000,
TAUT CHOLANGIOGRAM CATH,6255130,CDM,272,RC,,,OUTPATIENT,,,253.00,101.20,,,,,,other ,not seperately reimbursable,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.8,60,,121.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,215.05,85,,172.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,177.1,70,,141.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,80.96,32,,64.77,percent of total billed charges,32% of total billed charges,80.96,215.05,
POLYPECTOMY 15 MIN PER,6256871,CDM,750,RC,,,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,200.6,
HEMRRHOID BANDS,6256981,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE C013D,6258092,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
INTRODUCER TAUT,6260931,CDM,272,RC,C1894,HCPCS,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
REMOVAL OF 2ND MEM CATARACT,6266830,CDM,360,RC,66830,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,874.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,591,3356.65,
REMOVAL OF LENS MATERIAL,6266850,CDM,360,RC,66850,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,970.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,935,3356.65,
REM OF LENS MAT INTRACAPSULAR,6266920,CDM,360,RC,66920,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,922.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,591,3356.65,
REM OF LENS MAT EXTRACAPSULAR,6266940,CDM,360,RC,66940,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,966.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,674,3356.65,
CATARACT REMOVAL COMPLEX,6266982,CDM,360,RC,66982,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,919.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,919.31,3356.65,
CARATRACT REMOVAL PLAIN,6266984,CDM,360,RC,66984,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,670.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,670.75,3356.65,
INSERTION OF INTRO LENS PROS,6266985,CDM,360,RC,66985,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,785,100,,,fee schedule,100% of BCBS ASC tier groupings rate,785,100,,,fee schedule,100% of BCBS ASC tier groupings rate,785,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,947.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,785,3356.65,
EAR TUBES,6293990,CDM,272,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
AMBULATORY SURGICAL CARE,6302131,CDM,490,RC,,,OUTPATIENT,,,180.00,72.00,,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108,60,,86.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,126,70,,100.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,153,
TREAT RM OR 1-60 MINUTES,6302190,CDM,761,RC,,,OUTPATIENT,,,377.00,150.80,,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.2,60,,180.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,263.9,70,,211.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,32,,96.51,percent of total billed charges,32% of total billed charges,120.64,320.45,
TREAT RM OR EA ADD HR,6302195,CDM,761,RC,,,OUTPATIENT,,,190.00,76.00,,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114,60,,91.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,133,70,,106.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,32,,48.64,percent of total billed charges,32% of total billed charges,60.8,161.5,
SUTURE J340H,6900130,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J945H,6900133,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J980H,6900135,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J492H,6900137,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SUTURE J105T,6900138,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
SUTURE J104T,6900139,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
SUTURE J219H,6900142,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE J103T,6900146,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
SUTURE J422H,6900147,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SUTURE J422H,6900150,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE J423H,6900151,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUTURE J213H,6900152,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ARTHROCARE WAND,6900156,CDM,272,RC,,,OUTPATIENT,,,563.00,225.20,,,,,,other ,not seperately reimbursable,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,337.8,60,,270.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,478.55,85,,382.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,394.1,70,,315.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,180.16,32,,144.13,percent of total billed charges,32% of total billed charges,180.16,478.55,
"INS INTRAOCULAR DRN, INT INSERT",6900157,CDM,278,RC,0671T,HCPCS,OUTPATIENT,,,7649.00,3059.60,,3059.6,40,,,percent of total billed charges,40% of total billed charges,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4589.4,60,,3671.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,6501.65,85,,5201.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,5354.3,70,,4283.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,2447.68,32,,1958.14,percent of total billed charges,32% of total billed charges,2447.68,6501.65,
"INS INTRAOCULAR DRN, EA ADNL INSERT",6900158,CDM,360,RC,66183,HCPCS,OUTPATIENT,,,3059.00,1223.60,,3000,100,,,case rate,pays based on per visit rate,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1835.4,60,,1468.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1267.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,2600.15,85,,2080.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,2141.3,70,,1713.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,978.88,32,,783.1,percent of total billed charges,32% of total billed charges,978.88,3000,
EXT CAP CATARACT REM/INST LENS 1 STG,6900159,CDM,360,RC,66984,HCPCS,OUTPATIENT,,,3949.00,1579.60,,3000,100,,,case rate,pays based on per visit rate,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,923,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2369.4,60,,1895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,670.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,3356.65,85,,2685.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,2764.3,70,,2211.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,1263.68,32,,1010.94,percent of total billed charges,32% of total billed charges,670.75,3356.65,
STENT TRABECULAR MICRO BYPASS,6900160,CDM,278,RC,C1783,HCPCS,OUTPATIENT,,,4938.00,1975.20,,,,,,other ,not seperately reimbursable,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2962.8,60,,2370.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1975.2,40,,1580.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,4197.3,85,,3357.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,3456.6,70,,2765.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,1580.16,32,,1264.13,percent of total billed charges,32% of total billed charges,1580.16,4197.3,
PRISM LEFT HAND,6900161,CDM,272,RC,,,OUTPATIENT,,,1313.00,525.20,,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,787.8,60,,630.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,525.2,40,,420.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,919.1,70,,735.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,1116.05,
PRISM LEFT HAND OPEN ACCESS,6900162,CDM,272,RC,,,OUTPATIENT,,,1313.00,525.20,,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,787.8,60,,630.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,525.2,40,,420.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,1116.05,85,,892.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,919.1,70,,735.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,32,,336.13,percent of total billed charges,32% of total billed charges,420.16,1116.05,
PRISM LEFT HAND LT GONIO,6900163,CDM,272,RC,,,OUTPATIENT,,,250.00,100.00,,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,100,40,,80,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,80,212.5,
ARTHRO TX TIBIAL FX PROX UNICON,6900164,CDM,360,RC,29855,HCPCS,OUTPATIENT,,,15981.00,6392.40,,3000,100,,,case rate,pays based on per visit rate,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9588.6,60,,7670.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1018.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,13583.85,85,,10867.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,11186.7,70,,8949.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,1000,13583.85,
ARTHRO TX TIBIAL FX PROX BICON,6900165,CDM,360,RC,29856,HCPCS,OUTPATIENT,,,15981.00,6392.40,,3000,100,,,case rate,pays based on per visit rate,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9588.6,60,,7670.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1297.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,13583.85,85,,10867.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,11186.7,70,,8949.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,1000,13583.85,
UNLISTED PROC FEMUR/KNEE,6900166,CDM,360,RC,27599,HCPCS,OUTPATIENT,,,390.00,156.00,,3000,100,,,case rate,pays based on per visit rate,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,3000,
UNLISTED PROC ARTHROSCOPY,6900167,CDM,360,RC,29999,HCPCS,OUTPATIENT,,,3292.00,1316.80,,3000,100,,,case rate,pays based on per visit rate,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1975.2,60,,1580.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2798.2,85,,2238.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2304.4,70,,1843.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1000,3000,
OPN TX CALCAEAL FX,6900168,CDM,360,RC,28415,HCPCS,OUTPATIENT,,,15981.00,6392.40,,3000,100,,,case rate,pays based on per visit rate,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9588.6,60,,7670.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1459.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,13583.85,85,,10867.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,11186.7,70,,8949.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,5113.92,32,,4091.14,percent of total billed charges,32% of total billed charges,479,13583.85,
OPN TX TALUS FX,6900169,CDM,360,RC,28445,HCPCS,OUTPATIENT,,,11242.00,4496.80,,3000,100,,,case rate,pays based on per visit rate,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6745.2,60,,5396.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1325.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,9555.7,85,,7644.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,7869.4,70,,6295.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,479,9555.7,
TX TARSAL BNE FX EA,6900170,CDM,360,RC,28450,HCPCS,OUTPATIENT,,,537.00,214.80,,3000,100,,,case rate,pays based on per visit rate,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,322.2,60,,257.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,267.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,375.9,70,,300.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,32,,137.47,percent of total billed charges,32% of total billed charges,171.84,3000,
OPN TX TARSAL BNE FX EA,6900171,CDM,360,RC,28465,HCPCS,OUTPATIENT,,,11242.00,4496.80,,3000,100,,,case rate,pays based on per visit rate,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6745.2,60,,5396.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,817.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,9555.7,85,,7644.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,7869.4,70,,6295.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,479,9555.7,
ARTHRO REP OD LES/TALAR DME FX/TIB PL,6900172,CDM,360,RC,29892,HCPCS,OUTPATIENT,,,5420.00,2168.00,,3000,100,,,case rate,pays based on per visit rate,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3252,60,,2601.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,818.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,4607,85,,3685.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,3794,70,,3035.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,1734.4,32,,1387.52,percent of total billed charges,32% of total billed charges,818.15,4607,
UNLISTED PROC LEG/ANKLE,6900173,CDM,360,RC,27899,HCPCS,OUTPATIENT,,,390.00,156.00,,3000,100,,,case rate,pays based on per visit rate,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,3000,
UNLISTED PROC FOOT OR TOES,6900174,CDM,360,RC,28899,HCPCS,OUTPATIENT,,,390.00,156.00,,3000,100,,,case rate,pays based on per visit rate,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,3000,
UNLISTED PROC PELVIS OR HIP,6900175,CDM,360,RC,27299,HCPCS,OUTPATIENT,,,390.00,156.00,,3000,100,,,case rate,pays based on per visit rate,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,3000,
UNLISTED PRO SHOULDER,6900176,CDM,360,RC,23929,HCPCS,OUTPATIENT,,,390.00,156.00,,3000,100,,,case rate,pays based on per visit rate,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,3000,
CLOSE ANAL FISTULA W/ADV FLAP,6900177,CDM,360,RC,46288,HCPCS,OUTPATIENT,,,5197.00,2078.80,,3000,100,,,case rate,pays based on per visit rate,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3118.2,60,,2494.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,723.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,4417.45,85,,3533.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,3637.9,70,,2910.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,1663.04,32,,1330.43,percent of total billed charges,32% of total billed charges,591,4417.45,
NEEDLE BX BREAST W/O GUIDANCE,6900178,CDM,360,RC,19100,HCPCS,OUTPATIENT,,,3026.00,1210.40,,3000,100,,,case rate,pays based on per visit rate,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1815.6,60,,1452.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,198.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2572.1,85,,2057.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,2118.2,70,,1694.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,968.32,32,,774.66,percent of total billed charges,32% of total billed charges,198.88,3000,
ARTHRO SHLDR W/DECOMP OF SUB ACROMIAL SP,6900179,CDM,360,RC,29826,HCPCS,OUTPATIENT,,,300.00,120.00,,3000,100,,,case rate,pays based on per visit rate,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,3000,
ARTHRO SHLDR W/ROTATOR CUFF REP,6900180,CDM,360,RC,29827,HCPCS,OUTPATIENT,,,12587.00,5034.80,,3000,100,,,case rate,pays based on per visit rate,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7552.2,60,,6041.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1394.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,10698.95,85,,8559.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,8810.9,70,,7048.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,1000,10698.95,
ARTHRO SHLDR W/BICEPS TENODESIS,6900181,CDM,360,RC,29828,HCPCS,OUTPATIENT,,,12587.00,5034.80,,3000,100,,,case rate,pays based on per visit rate,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7552.2,60,,6041.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1196.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,10698.95,85,,8559.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,8810.9,70,,7048.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,1196.38,10698.95,
DESTUCT PRE-MALIGNANT LESIONS 2-14,6900182,CDM,360,RC,17003,HCPCS,OUTPATIENT,,,150.00,60.00,,3000,100,,,case rate,pays based on per visit rate,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,8.23,3000,
DESTUCT PRE-MALIGNANT LESION FIRST,6900183,CDM,360,RC,17000,HCPCS,OUTPATIENT,,,379.00,151.60,,3000,100,,,case rate,pays based on per visit rate,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.4,60,,181.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,265.3,70,,212.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,83.94,3000,
ARTHRO ANKLE W/PART SYNOVECTOMY,6900184,CDM,360,RC,29895,HCPCS,OUTPATIENT,,,5839.00,2335.60,,3000,100,,,case rate,pays based on per visit rate,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3503.4,60,,2802.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,604.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,4963.15,85,,3970.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,4087.3,70,,3269.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,1868.48,32,,1494.78,percent of total billed charges,32% of total billed charges,604.08,4963.15,
REP SECNDRY COLLATERAL ANKLE LIGAMENT,6900185,CDM,360,RC,27698,HCPCS,OUTPATIENT,,,12587.00,5034.80,,3000,100,,,case rate,pays based on per visit rate,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7552.2,60,,6041.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,824.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,10698.95,85,,8559.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,8810.9,70,,7048.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,419,10698.95,
REP SECNDRY COLLATERAL ANKLE LIGAMENT,6900186,CDM,360,RC,27792,HCPCS,OUTPATIENT,,,12587.00,5034.80,,3000,100,,,case rate,pays based on per visit rate,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7552.2,60,,6041.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,838.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,10698.95,85,,8559.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,8810.9,70,,7048.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,479,10698.95,
"LIGAMENTUS RECON, KNEE EXTRA ARTICULAR",6900187,CDM,360,RC,27427,HCPCS,OUTPATIENT,,,12587.00,5034.80,,3000,100,,,case rate,pays based on per visit rate,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7552.2,60,,6041.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,927.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,10698.95,85,,8559.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,8810.9,70,,7048.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,479,10698.95,
TENDON SHEATH INCISION,6900188,CDM,360,RC,26055,HCPCS,OUTPATIENT,,,3031.00,1212.40,,3000,100,,,case rate,pays based on per visit rate,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1818.6,60,,1454.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,750.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,2576.35,85,,2061.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,2121.7,70,,1697.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,969.92,32,,775.94,percent of total billed charges,32% of total billed charges,419,3000,
ARTHRO SHLDR BICEPS TENODESIS,6900190,CDM,360,RC,29828,HCPCS,OUTPATIENT,,,12587.00,5034.80,,3000,100,,,case rate,pays based on per visit rate,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7552.2,60,,6041.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1196.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,10698.95,85,,8559.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,8810.9,70,,7048.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,1196.38,10698.95,
MODIFIED MASTECTOMY W/O NODES,6900191,CDM,360,RC,19307,HCPCS,OUTPATIENT,,,10803.00,4321.20,,3000,100,,,case rate,pays based on per visit rate,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,3300,100,,,fee schedule,100% of BCBS ASC tier groupings rate,3300,100,,,fee schedule,100% of BCBS ASC tier groupings rate,3300,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6481.8,60,,5185.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1576.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,9182.55,85,,7346.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,7562.1,70,,6049.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,3456.96,32,,2765.57,percent of total billed charges,32% of total billed charges,1576.81,9182.55,
"DES B9 LESIONS LASER,ELECTRO CRYO, CHEMO",6900192,CDM,360,RC,17111,HCPCS,OUTPATIENT,,,379.00,151.60,,3000,100,,,case rate,pays based on per visit rate,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.4,60,,181.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,265.3,70,,212.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,3000,
"MASTECTOMY, MOD RAD W/AXILLARY NODES",6900193,CDM,360,RC,19307,HCPCS,OUTPATIENT,,,10122.00,4048.80,,3000,100,,,case rate,pays based on per visit rate,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,3300,100,,,fee schedule,100% of BCBS ASC tier groupings rate,3300,100,,,fee schedule,100% of BCBS ASC tier groupings rate,3300,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6073.2,60,,4858.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1576.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,8603.7,85,,6882.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,7085.4,70,,5668.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,3239.04,32,,2591.23,percent of total billed charges,32% of total billed charges,1576.81,8603.7,
REP INITIAL INCIS/VENTRAL HERNIA REDUCIB,6900194,CDM,360,RC,49560,HCPCS,OUTPATIENT,,,6535.00,2614.00,,3000,100,,,case rate,pays based on per visit rate,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3921,60,,3136.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,989.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,5554.75,85,,4443.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,4574.5,70,,3659.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,2091.2,32,,1672.96,percent of total billed charges,32% of total billed charges,591,5554.75,
ADJ TISS TNSFR/REARRANGE SAL 10.1-30.0,6900195,CDM,360,RC,14021,HCPCS,OUTPATIENT,,,3521.00,1408.40,,3000,100,,,case rate,pays based on per visit rate,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2112.6,60,,1690.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1090.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2992.85,85,,2394.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2464.7,70,,1971.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,3000,
EXC TUMOR SFT TISSUE SHLDR SUBQ 3CM OR >,6900196,CDM,360,RC,23071,HCPCS,OUTPATIENT,,,3027.00,1210.80,,3000,100,,,case rate,pays based on per visit rate,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1816.2,60,,1452.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,554.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,2572.95,85,,2058.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,554.13,3000,
ARTHRO SHLDR REP SLAP LESION,6900197,CDM,360,RC,29807,HCPCS,OUTPATIENT,,,12587.00,5034.80,,3000,100,,,case rate,pays based on per visit rate,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7552.2,60,,6041.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1347.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,10698.95,85,,8559.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,8810.9,70,,7048.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,4027.84,32,,3222.27,percent of total billed charges,32% of total billed charges,1000,10698.95,
COLONOSCOPY THRU STOMA W/BX,6900198,CDM,360,RC,44389,HCPCS,OUTPATIENT,,,2102.00,840.80,,3000,100,,,case rate,pays based on per visit rate,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1261.2,60,,1008.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,529.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1786.7,85,,1429.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,1471.4,70,,1177.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,672.64,32,,538.11,percent of total billed charges,32% of total billed charges,312,3000,
HEMORRHOIDOPEXY BY STAPLE,6900199,CDM,360,RC,46947,HCPCS,OUTPATIENT,,,5484.00,2193.60,,3000,100,,,case rate,pays based on per visit rate,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3290.4,60,,2632.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,511.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,4661.4,85,,3729.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,3838.8,70,,3071.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,1754.88,32,,1403.9,percent of total billed charges,32% of total billed charges,479,4661.4,
ARTHROPLASTY INTER POS IC OR CMC JNT,6900200,CDM,360,RC,25447,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1076.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,674,4948.7,
TRNSFR/TRANSPLNT TENDN CMC  W/O FREE GRA,6900201,CDM,360,RC,26480,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1013,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,479,4948.7,
EXC CYST/FIBRO BREAST TISS 1 IR MORE LES,6900202,CDM,360,RC,19120,HCPCS,OUTPATIENT,,,6249.00,2499.60,,3000,100,,,case rate,pays based on per visit rate,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3749.4,60,,2999.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,677.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,5311.65,85,,4249.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,4374.3,70,,3499.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,479,5311.65,
PERC SKLTL FXN PHLANGEAL FX FING/THMB EA,6900203,CDM,360,RC,26756,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,547.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,419,4948.7,
"HEMORRHOIDECTOMY, IN/EX, SNGL COL/GRP",6900204,CDM,360,RC,46255,HCPCS,OUTPATIENT,,,5181.00,2072.40,,3000,100,,,case rate,pays based on per visit rate,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3108.6,60,,2486.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,674,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,4403.85,85,,3523.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,3626.7,70,,2901.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,479,4403.85,
EXC B9 LESION SNHFG DIAMETER >4CM,6900205,CDM,360,RC,11426,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,427.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,419,4486.3,
LIVER BX NEEDLE W/OTHER PROCEDURE,6900206,CDM,360,RC,47001,HCPCS,OUTPATIENT,,,1221.00,488.40,,3000,100,,,case rate,pays based on per visit rate,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,732.6,60,,586.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,138.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,1037.85,85,,830.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,854.7,70,,683.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,390.72,32,,312.58,percent of total billed charges,32% of total billed charges,138.96,3000,
ARTHROSCOPY SHLDR DECOMPRESS W/LIGAMENT,6900207,CDM,360,RC,29826,HCPCS,OUTPATIENT,,,2329.00,931.60,,3000,100,,,case rate,pays based on per visit rate,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1397.4,60,,1117.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,1979.65,85,,1583.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,1630.3,70,,1304.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,745.28,32,,596.22,percent of total billed charges,32% of total billed charges,227.94,3000,
INJ SNGL TENDON SHTH OR LIGAMENT APONEUR,6900208,CDM,360,RC,20550,HCPCS,OUTPATIENT,,,549.00,219.60,,3000,100,,,case rate,pays based on per visit rate,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.4,60,,263.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,73.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,73.18,3000,
"EXC LESN TENDN SHTH OR JNT CAP, HAND/FIN",6900209,CDM,360,RC,26160,HCPCS,OUTPATIENT,,,2915.00,1166.00,,3000,100,,,case rate,pays based on per visit rate,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1749,60,,1399.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,781.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2040.5,70,,1632.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,479,3000,
ARTHRO KNEE W/LAT RELEASE,6900210,CDM,360,RC,29873,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,694.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,694.43,4948.7,
ARTHRO ACL REP/AUG/RECON,6900211,CDM,360,RC,29888,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1275.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,1000,10751.65,
AMP FINGER/THMB ANY JNT W/DIRECT CLOSEUR,6900212,CDM,360,RC,26951,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,900.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,419,4948.7,
REP/ADV FLEXOR TENDN W/O GRAFT EA TENDON,6900213,CDM,360,RC,26350,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,962.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,312,4948.7,
ADJ  TISS TRNSFR/REARRANGMNT 10CM OR <,6900214,CDM,360,RC,14000,HCPCS,OUTPATIENT,,,3437.00,1374.80,,3000,100,,,case rate,pays based on per visit rate,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2062.2,60,,1649.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,804.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,2921.45,85,,2337.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,2405.9,70,,1924.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,419,3000,
"INS, EXTERIOR TENDON SHEATH, WRIST",6900215,CDM,360,RC,25000,HCPCS,OUTPATIENT,,,2915.00,1166.00,,3000,100,,,case rate,pays based on per visit rate,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1749,60,,1399.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,441.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2040.5,70,,1632.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,441.9,3000,
"EXC, GANGLION WRIST, DOR OR VOL, PRIMARY",6900216,CDM,360,RC,25111,HCPCS,OUTPATIENT,,,2915.00,1166.00,,3000,100,,,case rate,pays based on per visit rate,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1749,60,,1399.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,416.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2040.5,70,,1632.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,416.66,3000,
"EXC, TUMR, SFT TISS, UA/ELBOW, SUBFASCIA",6900217,CDM,360,RC,24076,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,712.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,419,4486.3,
"DEBRIDE MUSCLE/FAC, EA ADDNL 20 SQCM",6900218,CDM,360,RC,11046,HCPCS,OUTPATIENT,,,750.00,300.00,,3000,100,,,case rate,pays based on per visit rate,240,32,,192,percent of total billed charges,32% of total billed charges,240,32,,192,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450,60,,360,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,95.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,637.5,85,,510,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,240,32,,192,percent of total billed charges,32% of total billed charges,525,70,,420,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,240,32,,192,percent of total billed charges,32% of total billed charges,95.55,3000,
"EXCISION OF LESIONS, ANUS, SIMPLE",6900219,CDM,360,RC,46922,HCPCS,OUTPATIENT,,,5181.00,2072.40,,3000,100,,,case rate,pays based on per visit rate,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3108.6,60,,2486.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,400.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,4403.85,85,,3523.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,3626.7,70,,2901.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,312,4403.85,
"EXCISION B9 LESION TAL, DIA >4CM",6900220,CDM,360,RC,11406,HCPCS,OUTPATIENT,,,3053.00,1221.20,,3000,100,,,case rate,pays based on per visit rate,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1831.8,60,,1465.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,409.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2595.05,85,,2076.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2137.1,70,,1709.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,409.51,3000,
EXC TUMR SFT TISS FOOT/TOE <1.5CM,6900221,CDM,360,RC,28043,HCPCS,OUTPATIENT,,,3253.00,1301.20,,3000,100,,,case rate,pays based on per visit rate,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1951.8,60,,1561.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,479.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,2765.05,85,,2212.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,2277.1,70,,1821.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,1040.96,32,,832.77,percent of total billed charges,32% of total billed charges,419,3000,
INSERT CVA DEV W/SUBQ PORT 5YO OR >,6900222,CDM,360,RC,36571,HCPCS,OUTPATIENT,,,5862.00,2344.80,,3000,100,,,case rate,pays based on per visit rate,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3517.2,60,,2813.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1653.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,4982.7,85,,3986.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,4103.4,70,,3282.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,479,4982.7,
MANIPULATION OF KNEE W/GEN ANESTH,6900223,CDM,360,RC,27570,HCPCS,OUTPATIENT,,,2915.00,1166.00,,3000,100,,,case rate,pays based on per visit rate,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1749,60,,1399.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,197.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2040.5,70,,1632.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,197.06,3000,
REP TENDON/MUSCLE UPER ARM PRI/SEC,6900224,CDM,360,RC,24341,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,964.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,479,10751.65,
EXC OLECRANON BURSAC,6900225,CDM,360,RC,24105,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,462.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,462.71,4948.7,
ARTHRO KNEE W/OSTEOCHRONDRAL GRAFT,6900226,CDM,360,RC,29866,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1372.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,1000,10751.65,
EXC TUMR NECK/ANT THORAX SUBQ 3CM OR>,6900227,CDM,360,RC,21552,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,590.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,590.33,4486.3,
EXC TUMR SFT TISS THIGH/KNEE  3CM OR>,6900228,CDM,360,RC,27337,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,553.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,553.54,4486.3,
"EXC B9 LESION TRNK,ARM,LEG 1.1-2.0 CM",6900229,CDM,360,RC,11402,HCPCS,OUTPATIENT,,,1286.00,514.40,,3000,100,,,case rate,pays based on per visit rate,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,216.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,216.89,3000,
ADJ TISS REARRANGE SAL 10 SQ CM OR <,6900230,CDM,360,RC,14020,HCPCS,OUTPATIENT,,,3437.00,1374.80,,3000,100,,,case rate,pays based on per visit rate,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2062.2,60,,1649.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,882.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,2921.45,85,,2337.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,2405.9,70,,1924.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,479,3000,
INSERT TUNNELED CATH W/PORT 5 Y/O OR >,6900231,CDM,360,RC,36561,HCPCS,OUTPATIENT,,,5862.00,2344.80,,3000,100,,,case rate,pays based on per visit rate,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3517.2,60,,2813.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1280.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,4982.7,85,,3986.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,4103.4,70,,3282.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,1875.84,32,,1500.67,percent of total billed charges,32% of total billed charges,479,4982.7,
EXCISE MULTI EXT PAPILLAE/TAGS ANUS,6900232,CDM,360,RC,46230,HCPCS,OUTPATIENT,,,5181.00,2072.40,,3000,100,,,case rate,pays based on per visit rate,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3108.6,60,,2486.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,398.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,4403.85,85,,3523.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,3626.7,70,,2901.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,312,4403.85,
LAP SURG W/ASP OF CAVITY/CYST,6900233,CDM,360,RC,49322,HCPCS,OUTPATIENT,,,10199.00,4079.60,,3000,100,,,case rate,pays based on per visit rate,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6119.4,60,,4895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,499.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,8669.15,85,,6935.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,7139.3,70,,5711.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,499.36,8669.15,
HEMORRHOIDECTOMY EXT 2+ GROUPS,6900234,CDM,360,RC,46250,HCPCS,OUTPATIENT,,,5181.00,2072.40,,3000,100,,,case rate,pays based on per visit rate,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3108.6,60,,2486.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,616.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,4403.85,85,,3523.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,3626.7,70,,2901.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,479,4403.85,
REP NON-UNION METATARSAL W/W/O GRAFT,6900235,CDM,360,RC,28322,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,994.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,591,10751.65,
REP WOUND 2.5CM OR < FENL MUCOUS M,6900236,CDM,360,RC,12051,HCPCS,OUTPATIENT,,,697.00,278.80,,3000,100,,,case rate,pays based on per visit rate,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.2,60,,334.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,357.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,487.9,70,,390.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,3000,
EXC TUMR SOFT TISS PEL/HIP 3CM OR >,6900237,CDM,360,RC,27043,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,621.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,621.16,4486.3,
PUNCH BX SINGLE LESION,6900238,CDM,360,RC,11104,HCPCS,OUTPATIENT,,,392.00,156.80,,3000,100,,,case rate,pays based on per visit rate,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.2,60,,188.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,274.4,70,,219.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,3000,
"EXC TUMOR SOFT TISS ABD WALL, 3CM OR >",6900239,CDM,360,RC,22903,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,583.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,583.61,4486.3,
REP PRIMARY TORN LIG KNEE COLLATERAL,6900240,CDM,360,RC,27405,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,882.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,591,10751.65,
ARTHROTOMY W/MENISCUS REP KNEE,6900241,CDM,360,RC,27403,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,841.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,591,4948.7,
REP INT FEM HERNIA INCAR/STRANGULATE,6900242,CDM,360,RC,49553,HCPCS,OUTPATIENT,,,6541.00,2616.40,,3000,100,,,case rate,pays based on per visit rate,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3924.6,60,,3139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,848.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,5559.85,85,,4447.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,4578.7,70,,3662.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,848.46,5559.85,
REINSERT RUPTD BI/TRCEPTS TENDON,6900243,CDM,360,RC,24342,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1011.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,479,10751.65,
EXC MALIGNANT LESION SNHFG 3.1-4.0 CM,6900244,CDM,360,RC,11624,HCPCS,OUTPATIENT,,,3053.00,1221.20,,3000,100,,,case rate,pays based on per visit rate,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1831.8,60,,1465.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,426.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2595.05,85,,2076.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2137.1,70,,1709.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,419,3000,
SPLIT THICK FSEMNEOGHFD 1ST 100CM OR<,6900245,CDM,360,RC,15120,HCPCS,OUTPATIENT,,,6139.00,2455.60,,3000,100,,,case rate,pays based on per visit rate,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3683.4,60,,2946.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1080.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,5218.15,85,,4174.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,4297.3,70,,3437.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,419,5218.15,
EXC TUMOR SOFT TISS FACE/SCALP 2CM OR >,6900246,CDM,360,RC,21012,HCPCS,OUTPATIENT,,,3053.00,1221.20,,3000,100,,,case rate,pays based on per visit rate,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1831.8,60,,1465.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,440.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2595.05,85,,2076.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2137.1,70,,1709.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,440.08,3000,
ARTHRO SHOULDER W/CAPSULORRHAPHY,6900247,CDM,360,RC,29806,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1000,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1381.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,1000,10751.65,
"FNB W/US GUIDANCE, EA ADDNL LESION",6900248,CDM,360,RC,10006,HCPCS,OUTPATIENT,,,250.00,100.00,,3000,100,,,case rate,pays based on per visit rate,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,77.08,3000,
ADJ TISS TNSFR/REAGRMT 30.1-61.0 CM,6900249,CDM,360,RC,14301,HCPCS,OUTPATIENT,,,6139.00,2455.60,,3000,100,,,case rate,pays based on per visit rate,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3683.4,60,,2946.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1378.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,5218.15,85,,4174.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,4297.3,70,,3437.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,1964.48,32,,1571.58,percent of total billed charges,32% of total billed charges,591,5218.15,
DIL FEMALE URETHRA W/ANESTHESIA,6900250,CDM,360,RC,53665,HCPCS,OUTPATIENT,,,3861.00,1544.40,,3000,100,,,case rate,pays based on per visit rate,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2316.6,60,,1853.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,49.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,3281.85,85,,2625.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,2702.7,70,,2162.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,1235.52,32,,988.42,percent of total billed charges,32% of total billed charges,49.64,3281.85,
LYSIS OF LABIAL ADHESIONS,6900251,CDM,360,RC,56441,HCPCS,OUTPATIENT,,,5240.00,2096.00,,3000,100,,,case rate,pays based on per visit rate,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3144,60,,2515.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,237,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,4454,85,,3563.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,3668,70,,2934.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,237,4454,
SPLIT THICK AUTOGRAFT 100 SQ CM OR <,6900252,CDM,360,RC,15100,HCPCS,OUTPATIENT,,,3248.00,1299.20,,3000,100,,,case rate,pays based on per visit rate,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1948.8,60,,1559.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1119.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,2760.8,85,,2208.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,2273.6,70,,1818.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,419,3000,
EXC MALIG LESION W/MARGINS 3.1-40 CM,6900253,CDM,360,RC,11604,HCPCS,OUTPATIENT,,,1215.00,486.00,,3000,100,,,case rate,pays based on per visit rate,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,729,60,,583.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,391.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,1032.75,85,,826.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,850.5,70,,680.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,388.8,32,,311.04,percent of total billed charges,32% of total billed charges,388.8,3000,
ADJ TISS TNSFR FCCMNAGHF 10.1-30 SQCM,6900254,CDM,360,RC,14041,HCPCS,OUTPATIENT,,,3248.00,1299.20,,3000,100,,,case rate,pays based on per visit rate,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1948.8,60,,1559.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1156,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,2760.8,85,,2208.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,2273.6,70,,1818.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,1039.36,32,,831.49,percent of total billed charges,32% of total billed charges,479,3000,
REM TUNNELED CVA W/PORT OR PUMP,6900255,CDM,360,RC,36590,HCPCS,OUTPATIENT,,,1376.00,550.40,,3000,100,,,case rate,pays based on per visit rate,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,825.6,60,,660.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,292.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,1169.6,85,,935.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,963.2,70,,770.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,440.32,32,,352.26,percent of total billed charges,32% of total billed charges,292.53,3000,
US FINE NEEDLE ASPIRATION W/IMAGING,6900256,CDM,360,RC,10005,HCPCS,OUTPATIENT,,,1286.00,514.40,,3000,100,,,case rate,pays based on per visit rate,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,174.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,174.44,3000,
REP PRIMARY OPN/PERC REPTURED TENDON,6900257,CDM,360,RC,27650,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,849.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,479,4948.7,
REP INCISIONAL/VENTRAL HERNIA INC/STRANG,6900258,CDM,360,RC,49561,HCPCS,OUTPATIENT,,,6541.00,2616.40,,3000,100,,,case rate,pays based on per visit rate,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3924.6,60,,3139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1248.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,5559.85,85,,4447.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,4578.7,70,,3662.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,2093.12,32,,1674.5,percent of total billed charges,32% of total billed charges,1248.24,5559.85,
IMPLANT MESH OPN INC/VENT HERNIA REP,6900259,CDM,360,RC,49568,HCPCS,OUTPATIENT,,,1000.00,400.00,,3000,100,,,case rate,pays based on per visit rate,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,600,60,,480,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,358.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,850,85,,680,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,700,70,,560,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,320,3000,
EXC PILONIDAL CYST/SINUS COMPLICATED,6900260,CDM,360,RC,11772,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1005.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,479,4486.3,
CORRECT HALLUX VALGUS ANY METHOD,6900261,CDM,360,RC,28295,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1371.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,479,4948.7,
OSTEOTOMY METATARSAL EA OTHER THAN 1ST,6900262,CDM,360,RC,28308,HCPCS,OUTPATIENT,,,5822.00,2328.80,,3000,100,,,case rate,pays based on per visit rate,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3493.2,60,,2794.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,713.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4948.7,85,,3958.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,4075.4,70,,3260.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,1863.04,32,,1490.43,percent of total billed charges,32% of total billed charges,419,4948.7,
ARTHROPLASTY GLENOHUMERAL JNT,6900263,CDM,360,RC,23472,HCPCS,OUTPATIENT,,,14650.00,5860.00,,3000,100,,,case rate,pays based on per visit rate,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8790,60,,7032,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1892.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,12452.5,85,,9962,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,10255,70,,8204,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,4688,32,,3750.4,percent of total billed charges,32% of total billed charges,1892.29,12452.5,
OPN TX METATARSAL FX EA,6900264,CDM,360,RC,28485,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,716.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,591,10751.65,
"D&C, DX OR TX",6900265,CDM,360,RC,58120,HCPCS,OUTPATIENT,,,5240.00,2096.00,,3000,100,,,case rate,pays based on per visit rate,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3144,60,,2515.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,386.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,4454,85,,3563.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,3668,70,,2934.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,1676.8,32,,1341.44,percent of total billed charges,32% of total billed charges,386.29,4454,
"MASTECTOMY, PARTIAL",6900266,CDM,360,RC,19301,HCPCS,OUTPATIENT,,,6249.00,2499.60,,3000,100,,,case rate,pays based on per visit rate,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3749.4,60,,2999.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,882.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,5311.65,85,,4249.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,4374.3,70,,3499.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,1999.68,32,,1599.74,percent of total billed charges,32% of total billed charges,479,5311.65,
"RAD EXCISION BURSA WRIST/FOREARM, FLEXOR",6900267,CDM,360,RC,25115,HCPCS,OUTPATIENT,,,2915.00,1166.00,,3000,100,,,case rate,pays based on per visit rate,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1749,60,,1399.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,977.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2040.5,70,,1632.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,591,3000,
INSERT PICC LINE W/O PORT => 5Y/O,6900268,CDM,360,RC,36573,HCPCS,OUTPATIENT,,,2427.00,970.80,,3000,100,,,case rate,pays based on per visit rate,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1456.2,60,,1164.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,490.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,2062.95,85,,1650.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,490.51,3000,
UNLISTED LAP PROCEDURE LIVER,6900269,CDM,360,RC,47379,HCPCS,OUTPATIENT,,,10199.00,4079.60,,3000,100,,,case rate,pays based on per visit rate,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6119.4,60,,4895.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,8669.15,85,,6935.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,7139.3,70,,5711.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,3263.68,32,,2610.94,percent of total billed charges,32% of total billed charges,3000,8669.15,
MANI W/ANES SHOULDER JOINT,6900270,CDM,360,RC,23700,HCPCS,OUTPATIENT,,,2915.00,1166.00,,3000,100,,,case rate,pays based on per visit rate,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1749,60,,1399.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,254.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,2040.5,70,,1632.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,932.8,32,,746.24,percent of total billed charges,32% of total billed charges,254.53,3000,
REPLACE PICC LINE W/IMAGING,6900271,CDM,360,RC,36584,HCPCS,OUTPATIENT,,,2427.00,970.80,,3000,100,,,case rate,pays based on per visit rate,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1456.2,60,,1164.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,2062.95,85,,1650.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,312,3000,
FISSURECTOMY W/SPHINCTEROTOMY IF PERFRMD,6900272,CDM,360,RC,46200,HCPCS,OUTPATIENT,,,5181.00,2072.40,,3000,100,,,case rate,pays based on per visit rate,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3108.6,60,,2486.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,605.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,4403.85,85,,3523.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,3626.7,70,,2901.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,419,4403.85,
EXC PILONIDAL CYST/SINUS COMPLICATED,6900273,CDM,360,RC,11772,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1005.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,479,4486.3,
"EXC B9 LESION TAL , 3.1CM-4.0CM",6900274,CDM,360,RC,11404,HCPCS,OUTPATIENT,,,3053.00,1221.20,,3000,100,,,case rate,pays based on per visit rate,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1831.8,60,,1465.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,285,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2595.05,85,,2076.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,2137.1,70,,1709.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,976.96,32,,781.57,percent of total billed charges,32% of total billed charges,285,3000,
"REMOVAL OF IMPLANT, DEEP (EG, SCREW, WIR",6900275,CDM,360,RC,20680,HCPCS,OUTPATIENT,,,5278.00,2111.20,,3000,100,,,case rate,pays based on per visit rate,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,768.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,479,4486.3,
"CORRECTION, HAMMERTOE",6900276,CDM,360,RC,28285,HCPCS,OUTPATIENT,,,5821.00,2328.40,,3000,100,,,case rate,pays based on per visit rate,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3492.6,60,,2794.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,671.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,4947.85,85,,3958.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,4074.7,70,,3259.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,1862.72,32,,1490.18,percent of total billed charges,32% of total billed charges,479,4947.85,
"CORRECTION, HALLUX VALGUS W/SESAM",6900277,CDM,360,RC,28298,HCPCS,OUTPATIENT,,,12649.00,5059.60,,3000,100,,,case rate,pays based on per visit rate,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7589.4,60,,6071.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1042.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,10751.65,85,,8601.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,8854.3,70,,7083.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,4047.68,32,,3238.14,percent of total billed charges,32% of total billed charges,479,10751.65,
HEMORRHOIDOPEXY BY STAPLING,6900278,CDM,360,RC,46947,HCPCS,OUTPATIENT,,,5181.00,2072.40,,3000,100,,,case rate,pays based on per visit rate,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3108.6,60,,2486.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,511.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,4403.85,85,,3523.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,3626.7,70,,2901.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,1657.92,32,,1326.34,percent of total billed charges,32% of total billed charges,479,4403.85,
"ARTHROSCOPY, KNEE REM/DEBRIDE W/OTHR PRO",6900279,CDM,360,RC,G0289,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,112.08,
IMPL SYS AUTOGRAFT GRAFTLINK CP,6900280,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,8065.00,3226.00,,3226,40,,,percent of total billed charges,40% of total billed charges,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4839,60,,3871.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,6855.25,85,,5484.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,5645.5,70,,4516.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,2580.8,32,,2064.64,percent of total billed charges,32% of total billed charges,2580.8,6855.25,
FIBERSTITCH IMPLANT CURVED,6900281,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1947.00,778.80,,,,,,other ,not seperately reimbursable,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1168.2,60,,934.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,1654.95,85,,1323.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,1362.9,70,,1090.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,623.04,32,,498.43,percent of total billed charges,32% of total billed charges,623.04,1654.95,
SUTURE QUAD/HAMSTRING RUPTURE PRIMARY,6900282,CDM,360,RC,27385,HCPCS,OUTPATIENT,,,13275.00,5310.00,,3000,100,,,case rate,pays based on per visit rate,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7965,60,,6372,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,787.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,11283.75,85,,9027,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,9292.5,70,,7434,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,4248,32,,3398.4,percent of total billed charges,32% of total billed charges,479,11283.75,
IV INFUSION SEQUENTIAL INFUSION,6900285,CDM,262,RC,96367,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,37.08,113.9,
IV INFUSION CONCURRENT,6900286,CDM,262,RC,96368,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
IV PUSH INITIAL,6900287,CDM,262,RC,96374,HCPCS,OUTPATIENT,,,506.00,202.40,,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303.6,60,,242.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,354.2,70,,283.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,48.01,430.1,
IV PUSH SEQUENTIAL NEW DRUG,6900288,CDM,262,RC,96375,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,19.56,72.25,
IV PUSH SAME DRUG,6900289,CDM,262,RC,96376,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
BLOOD TRANSFUSION,6900290,CDM,391,RC,36430,HCPCS,OUTPATIENT,,,861.00,344.40,,,,,,other ,not seperately reimbursable,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.6,60,,413.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,731.85,85,,585.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,602.7,70,,482.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,275.52,32,,220.42,percent of total billed charges,32% of total billed charges,46.33,731.85,
IV CHEMOTHERAPY ADMIN UP TO 1 HR,6900291,CDM,335,RC,96413,HCPCS,OUTPATIENT,,,687.00,274.80,,96.85,80,,,fee schedule,80% of Aetna fee schedule,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.2,60,,329.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,167.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,583.95,85,,467.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,480.9,70,,384.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,219.84,32,,175.87,percent of total billed charges,32% of total billed charges,96.85,583.95,
IV CHEMOTHERAPY ADMIN EA ADDNL HR,6900292,CDM,335,RC,96415,HCPCS,OUTPATIENT,,,134.00,53.60,,21.38,80,,,fee schedule,80% of Aetna fee schedule,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,21.38,113.9,
"EXC B9 LESION TAL, 0.5CM OR <",6900293,CDM,360,RC,11400,HCPCS,OUTPATIENT,,,1478.00,591.20,,3000,100,,,case rate,pays based on per visit rate,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,886.8,60,,709.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,159.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,1034.6,70,,827.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,159.89,3000,
"EXC B9 LESION TAL, 0.6CM - 1.0CM",6900294,CDM,360,RC,11401,HCPCS,OUTPATIENT,,,774.00,309.60,,3000,100,,,case rate,pays based on per visit rate,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,464.4,60,,371.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,196.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,541.8,70,,433.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,247.68,32,,198.14,percent of total billed charges,32% of total billed charges,196.71,3000,
"EXC B9 LESION TAL, 2.1CM-3.0CM",6900295,CDM,360,RC,11403,HCPCS,OUTPATIENT,,,1478.00,591.20,,3000,100,,,case rate,pays based on per visit rate,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,886.8,60,,709.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,249.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,1256.3,85,,1005.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,1034.6,70,,827.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,472.96,32,,378.37,percent of total billed charges,32% of total billed charges,249.46,3000,
COMPLEX OR 1ST 30 MIN,6900296,CDM,360,RC,,,OUTPATIENT,,,10000.00,4000.00,,,,,,other ,not seperately reimbursable,3200,32,,2560,percent of total billed charges,32% of total billed charges,3200,32,,2560,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6000,60,,4800,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3200,32,,2560,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3200,32,,2560,percent of total billed charges,32% of total billed charges,8500,85,,6800,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3200,32,,2560,percent of total billed charges,32% of total billed charges,3200,32,,2560,percent of total billed charges,32% of total billed charges,7000,70,,5600,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3200,32,,2560,percent of total billed charges,32% of total billed charges,3200,32,,2560,percent of total billed charges,32% of total billed charges,3200,8500,
COMPLEX OR  31 TO 60 MIN,6900297,CDM,360,RC,,,OUTPATIENT,,,7500.00,3000.00,,,,,,other ,not seperately reimbursable,2400,32,,1920,percent of total billed charges,32% of total billed charges,2400,32,,1920,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4500,60,,3600,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2400,32,,1920,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2400,32,,1920,percent of total billed charges,32% of total billed charges,6375,85,,5100,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2400,32,,1920,percent of total billed charges,32% of total billed charges,2400,32,,1920,percent of total billed charges,32% of total billed charges,5250,70,,4200,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2400,32,,1920,percent of total billed charges,32% of total billed charges,2400,32,,1920,percent of total billed charges,32% of total billed charges,2400,6375,
COMPLEX OR EA ADDNL 30 MIN,6900298,CDM,360,RC,,,OUTPATIENT,,,5000.00,2000.00,,,,,,other ,not seperately reimbursable,1600,32,,1280,percent of total billed charges,32% of total billed charges,1600,32,,1280,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3000,60,,2400,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1600,32,,1280,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1600,32,,1280,percent of total billed charges,32% of total billed charges,4250,85,,3400,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1600,32,,1280,percent of total billed charges,32% of total billed charges,1600,32,,1280,percent of total billed charges,32% of total billed charges,3500,70,,2800,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1600,32,,1280,percent of total billed charges,32% of total billed charges,1600,32,,1280,percent of total billed charges,32% of total billed charges,1600,4250,
SURG LAP INITIAL INGUINAL HERNIA,6900299,CDM,360,RC,49650,HCPCS,OUTPATIENT,,,12260.00,4904.00,,3000,100,,,case rate,pays based on per visit rate,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7356,60,,5884.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,576.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,10421,85,,8336.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,8582,70,,6865.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,576.48,10421,
TOTAL KNEE ARTHROPLASTY,6900300,CDM,360,RC,27447,HCPCS,OUTPATIENT,,,29836.00,11934.40,,3000,100,,,case rate,pays based on per visit rate,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17901.6,60,,14321.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1680.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,25360.6,85,,20288.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,20885.2,70,,16708.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,9547.52,32,,7638.02,percent of total billed charges,32% of total billed charges,1680.25,25360.6,
ACL RECONSTRUCTION,6900301,CDM,360,RC,27407,HCPCS,OUTPATIENT,,,15178.00,6071.20,,3000,100,,,case rate,pays based on per visit rate,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9106.8,60,,7285.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1040.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,12901.3,85,,10321.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,10624.6,70,,8499.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,4856.96,32,,3885.57,percent of total billed charges,32% of total billed charges,591,12901.3,
BRONCOSCOPY W/BRUSHINGS,6900302,CDM,360,RC,31623,HCPCS,OUTPATIENT,,,3625.00,1450.00,,3000,100,,,case rate,pays based on per visit rate,1160,32,,928,percent of total billed charges,32% of total billed charges,1160,32,,928,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2175,60,,1740,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,350.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1160,32,,928,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1160,32,,928,percent of total billed charges,32% of total billed charges,3081.25,85,,2465,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1160,32,,928,percent of total billed charges,32% of total billed charges,1160,32,,928,percent of total billed charges,32% of total billed charges,2537.5,70,,2030,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1160,32,,928,percent of total billed charges,32% of total billed charges,1160,32,,928,percent of total billed charges,32% of total billed charges,350.01,3081.25,
OPSU SPEC COL EXTERNAL VAD,6900303,CDM,761,RC,36592,HCPCS,OUTPATIENT,,,271.00,108.40,,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.6,60,,130.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,35.95,230.35,
DECLOTTING VAD BY THOROMBOLYTICS,6900304,CDM,761,RC,36593,HCPCS,OUTPATIENT,,,753.00,301.20,,,,,,other ,not seperately reimbursable,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,451.8,60,,361.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,640.05,85,,512.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,527.1,70,,421.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,240.96,32,,192.77,percent of total billed charges,32% of total billed charges,39.83,640.05,
IV HYDRATION INIT 31 MIN TO 1 HR,6900305,CDM,260,RC,96360,HCPCS,OUTPATIENT,,,493.00,197.20,,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295.8,60,,236.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,345.1,70,,276.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,41.9,419.05,
IV HYDRATION IV ADDL HR,6900306,CDM,260,RC,96361,HCPCS,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,15.88,82.45,
IV INFUSION UP TO 1 HR,6900307,CDM,260,RC,96365,HCPCS,OUTPATIENT,,,493.00,197.20,,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295.8,60,,236.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,419.05,85,,335.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,345.1,70,,276.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,157.76,32,,126.21,percent of total billed charges,32% of total billed charges,82.65,419.05,
IV INFUSION ADDL HR,6900308,CDM,260,RC,96366,HCPCS,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,25.86,82.45,
PICC LINE OP INSERT W/O IMAGING,6936569,CDM,360,RC,36569,HCPCS,OUTPATIENT,,,3407.00,1362.80,,3000,100,,,case rate,pays based on per visit rate,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,121.45,3000,
PICC LINE OP INSERT WITH IMAGING,6936573,CDM,360,RC,36573,HCPCS,OUTPATIENT,,,3407.00,1362.80,,3000,100,,,case rate,pays based on per visit rate,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,490.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,490.51,3000,
"REP CVA OP CATH W/O P/P, W/C/P INS SITE",6936575,CDM,360,RC,36575,HCPCS,OUTPATIENT,,,1312.00,524.80,,3000,100,,,case rate,pays based on per visit rate,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,787.2,60,,629.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,188.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,1115.2,85,,892.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,918.4,70,,734.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,188.3,3000,
PICC REPL OP COMP W/O IMG SME VEIN ACCES,6936580,CDM,360,RC,36580,HCPCS,OUTPATIENT,,,3407.00,1362.80,,3000,100,,,case rate,pays based on per visit rate,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,243.5,3000,
PICC REPL OP COMP  W/IMG SV ACCES,6936584,CDM,360,RC,36584,HCPCS,OUTPATIENT,,,3407.00,1362.80,,3000,100,,,case rate,pays based on per visit rate,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,3000,
SURG LAP ENTEROLYSIS,6936585,CDM,360,RC,44180,HCPCS,OUTPATIENT,,,12260.00,4904.00,,3000,100,,,case rate,pays based on per visit rate,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7356,60,,5884.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1233.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,10421,85,,8336.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,8582,70,,6865.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,3923.2,32,,3138.56,percent of total billed charges,32% of total billed charges,674,10421,
PROVAYBLUE (METHYLENE BLUE) 1MG,6936586,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,10.46,4.18,,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,60,,5.02,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,8.89,85,,7.11,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,7.32,70,,5.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,8.89,
PROVAYBLUE (METHYLENE BLUE) 1MG WASTE,6936587,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,10.46,4.18,,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,60,,5.02,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,8.89,85,,7.11,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,7.32,70,,5.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,8.89,
NEG PRESS WND TX DISPOSABLE DEV <50S,6936588,CDM,360,RC,97607,HCPCS,OUTPATIENT,,,838.00,335.20,,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,502.8,60,,402.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,468.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,586.6,70,,469.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,712.3,
NEG PRESS WND TX DISPOSABLE DEV >50S,6936589,CDM,360,RC,97608,HCPCS,OUTPATIENT,,,838.00,335.20,,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,502.8,60,,402.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,462.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,712.3,85,,569.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,586.6,70,,469.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,32,,214.53,percent of total billed charges,32% of total billed charges,268.16,712.3,
"TENOTOMY ELBOW LAT OR MED, DEBRIDE ST/BO",6936590,CDM,360,RC,24359,HCPCS,OUTPATIENT,,,7007.00,2802.80,,3000,100,,,case rate,pays based on per visit rate,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4204.2,60,,3363.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,862.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,5955.95,85,,4764.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,4904.9,70,,3923.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,479,5955.95,
POSTERIOR COLPORRHAPHY REP RETROCELE,6936591,CDM,360,RC,57250,HCPCS,OUTPATIENT,,,10911.00,4364.40,,3000,100,,,case rate,pays based on per visit rate,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6546.6,60,,5237.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,806.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,9274.35,85,,7419.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,7637.7,70,,6110.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,3491.52,32,,2793.22,percent of total billed charges,32% of total billed charges,674,9274.35,
BX SALIVARY GLAND; NEEDLE,6936592,CDM,360,RC,42400,HCPCS,OUTPATIENT,,,1540.00,616.00,,3000,100,,,case rate,pays based on per visit rate,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,924,60,,739.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,1309,85,,1047.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,1078,70,,862.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,492.8,32,,394.24,percent of total billed charges,32% of total billed charges,123.81,3000,
"VASECTOMY, UNILATERAL/BILATERAL",6936593,CDM,360,RC,55250,HCPCS,OUTPATIENT,,,4430.00,1772.00,,3000,100,,,case rate,pays based on per visit rate,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2658,60,,2126.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,424.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,3765.5,85,,3012.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,3101,70,,2480.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,312,3765.5,
SURG PREP EXCISION OPN WND 1ST 100 SQ CM,6936594,CDM,360,RC,15004,HCPCS,OUTPATIENT,,,1296.00,518.40,,3000,100,,,case rate,pays based on per visit rate,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,777.6,60,,622.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,505.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,1101.6,85,,881.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,907.2,70,,725.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,414.72,32,,331.78,percent of total billed charges,32% of total billed charges,414.72,3000,
"FNB ASPIRATION, WITHOUT IMAGING",6936595,CDM,360,RC,10021,HCPCS,OUTPATIENT,,,855.00,342.00,,3000,100,,,case rate,pays based on per visit rate,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,513,60,,410.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,127.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,726.75,85,,581.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,598.5,70,,478.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,127.95,3000,
"AMPUTATION, METATARSOPHLANGEAL JOINT",6936596,CDM,360,RC,28820,HCPCS,OUTPATIENT,,,7007.00,2802.80,,3000,100,,,case rate,pays based on per visit rate,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4204.2,60,,3363.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,380.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,5955.95,85,,4764.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,4904.9,70,,3923.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,380.59,5955.95,
"LAPROSCOPY, SURGICAL WITH BX (SINGLE OR",6936597,CDM,360,RC,49321,HCPCS,OUTPATIENT,,,12520.00,5008.00,,3000,100,,,case rate,pays based on per visit rate,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7512,60,,6009.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,456.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,10642,85,,8513.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,8764,70,,7011.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,456.85,10642,
"LAPROSCOPY, SURGICAL W/REM OF ADNEXAL ST",6936598,CDM,360,RC,58661,HCPCS,OUTPATIENT,,,12520.00,5008.00,,3000,100,,,case rate,pays based on per visit rate,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7512,60,,6009.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,857.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,10642,85,,8513.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,8764,70,,7011.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,4006.4,32,,3205.12,percent of total billed charges,32% of total billed charges,674,10642,
"EXC MALIGNANT LESION FACE/EARS,  > 4CM",6936599,CDM,360,RC,11646,HCPCS,OUTPATIENT,,,5867.00,2346.80,,3000,100,,,case rate,pays based on per visit rate,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3520.2,60,,2816.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,646.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,4986.95,85,,3989.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,4106.9,70,,3285.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,419,4986.95,
"FULL THICKNESS GRAFT, FCCMNAGHF 20 SQ CM",6936600,CDM,360,RC,15241,HCPCS,OUTPATIENT,,,0.01,0.00,,3000,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,0.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,3000,
EXC OR CURETTAGE BONE CYST OR B9 TMR FEM,6936601,CDM,360,RC,27355,HCPCS,OUTPATIENT,,,7007.00,2802.80,,3000,100,,,case rate,pays based on per visit rate,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4204.2,60,,3363.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,793.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,5955.95,85,,4764.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,4904.9,70,,3923.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,479,5955.95,
INSERT NON-TUNNL CENTRAL VENOUS CATH 5 Y,6936602,CDM,360,RC,36556,HCPCS,OUTPATIENT,,,7083.00,2833.20,,3000,100,,,case rate,pays based on per visit rate,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4249.8,60,,3399.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,273.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,6020.55,85,,4816.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,4958.1,70,,3966.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,2266.56,32,,1813.25,percent of total billed charges,32% of total billed charges,273.35,6020.55,
SIMP REP SUPERFICIAL WNDS SNAT EXT GENIT,6936603,CDM,360,RC,12001,HCPCS,OUTPATIENT,,,444.00,177.60,,3000,100,,,case rate,pays based on per visit rate,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.4,60,,213.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,310.8,70,,248.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,119.59,3000,
"CYSTOURETHROSCOPY, W/DIL CYSTITS W/ANEST",6936604,CDM,360,RC,52260,HCPCS,OUTPATIENT,,,4430.00,1772.00,,3000,100,,,case rate,pays based on per visit rate,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2658,60,,2126.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,269.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,3765.5,85,,3012.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,3101,70,,2480.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,269.63,3765.5,
REP INTERMEDIATE WNDS SATE;  2.5 CM OR <,6936605,CDM,360,RC,12031,HCPCS,OUTPATIENT,,,855.00,342.00,,3000,100,,,case rate,pays based on per visit rate,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,513,60,,410.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,331.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,726.75,85,,581.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,598.5,70,,478.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,273.6,32,,218.88,percent of total billed charges,32% of total billed charges,273.6,3000,
PERCUT SKELETAL FIX SUPRA/TRANS HUM FX W,6936606,CDM,360,RC,24538,HCPCS,OUTPATIENT,,,15498.00,6199.20,,3000,100,,,case rate,pays based on per visit rate,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9298.8,60,,7439.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1029.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,13173.3,85,,10538.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,10848.6,70,,8678.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,4959.36,32,,3967.49,percent of total billed charges,32% of total billed charges,419,13173.3,
"EGD, FLEX, ORAL W/BAL DIL OF ESOPH W/GUI",6936607,CDM,360,RC,43233,HCPCS,OUTPATIENT,,,4019.00,1607.60,,3000,100,,,case rate,pays based on per visit rate,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2411.4,60,,1929.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,296.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,3416.15,85,,2732.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,2813.3,70,,2250.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,1286.08,32,,1028.86,percent of total billed charges,32% of total billed charges,296.98,3416.15,
BLADDER ASPIRATION W/SUPRAPUBIC CATH INS,6936608,CDM,360,RC,51102,HCPCS,OUTPATIENT,,,4430.00,1772.00,,3000,100,,,case rate,pays based on per visit rate,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2658,60,,2126.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,307.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,3765.5,85,,3012.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,3101,70,,2480.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,1417.6,32,,1134.08,percent of total billed charges,32% of total billed charges,307.01,3765.5,
"COLONOSCOPY, FELXIBLE; WITH BAND LIGATIO",6936609,CDM,360,RC,45398,HCPCS,OUTPATIENT,,,2566.00,1026.40,,3000,100,,,case rate,pays based on per visit rate,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1539.6,60,,1231.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1069.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,2181.1,85,,1744.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,1796.2,70,,1436.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,821.12,32,,656.9,percent of total billed charges,32% of total billed charges,821.12,3000,
"INCISION THROMBOSED HEMORRHOID, EXTERNAL",6936610,CDM,360,RC,46083,HCPCS,OUTPATIENT,,,658.00,263.20,,3000,100,,,case rate,pays based on per visit rate,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,394.8,60,,315.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,267.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,559.3,85,,447.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,460.6,70,,368.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,210.56,32,,168.45,percent of total billed charges,32% of total billed charges,210.56,3000,
BIOPSY OR EXICSION OF LYMPH NODE(S); BY,6936611,CDM,360,RC,38505,HCPCS,OUTPATIENT,,,3481.00,1392.40,,3000,100,,,case rate,pays based on per visit rate,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2088.6,60,,1670.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,223.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,2958.85,85,,2367.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,2436.7,70,,1949.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,1113.92,32,,891.14,percent of total billed charges,32% of total billed charges,223.69,3000,
"EXC, TMR, SOFT TISS  BACK/ FLANK, SUBFAS",6936612,CDM,360,RC,21932,HCPCS,OUTPATIENT,,,5867.00,2346.80,,3000,100,,,case rate,pays based on per visit rate,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520.2,60,,2816.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,876.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,4986.95,85,,3989.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,4106.9,70,,3285.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,1877.44,32,,1501.95,percent of total billed charges,32% of total billed charges,876.79,4986.95,
EXCISION OF SYNOVIAL CYST POPLITEAL SPAC,6936613,CDM,360,RC,27345,HCPCS,OUTPATIENT,,,7007.00,2802.80,,3000,100,,,case rate,pays based on per visit rate,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4204.2,60,,3363.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,632.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,5955.95,85,,4764.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,4904.9,70,,3923.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,2242.24,32,,1793.79,percent of total billed charges,32% of total billed charges,591,5955.95,
"REPLACE, TUNNELED CVC CATH  W/PORT",6936614,CDM,360,RC,36582,HCPCS,OUTPATIENT,,,7217.00,2886.80,,3000,100,,,case rate,pays based on per visit rate,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4330.2,60,,3464.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1147.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,6134.45,85,,4907.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,5051.9,70,,4041.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,2309.44,32,,1847.55,percent of total billed charges,32% of total billed charges,479,6134.45,
"REP ANT ABD HERNIA, ANY AP, TOT DEF 3-10",6936615,CDM,360,RC,49594,HCPCS,OUTPATIENT,,,12628.00,5051.20,,3000,100,,,case rate,pays based on per visit rate,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7576.8,60,,6061.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,10733.8,85,,8587.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,8839.6,70,,7071.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,3000,10733.8,
"REP ANT ABD HERNIA, ANY AP, TOT DEF < 3",6936616,CDM,360,RC,49591,HCPCS,OUTPATIENT,,,8581.00,3432.40,,3000,100,,,case rate,pays based on per visit rate,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5148.6,60,,4118.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,7293.85,85,,5835.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,6006.7,70,,4805.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,7293.85,
"REP ANT ABD HERNIA, ANY AP, TOT DEF < 3C",6936617,CDM,360,RC,49592,HCPCS,OUTPATIENT,,,12628.00,5051.20,,3000,100,,,case rate,pays based on per visit rate,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7576.8,60,,6061.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,10733.8,85,,8587.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,8839.6,70,,7071.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,3000,10733.8,
"REP ANT ABD HERNIA, ANY AP, TOT DEF < 3C",6936618,CDM,360,RC,49593,HCPCS,OUTPATIENT,,,8581.00,3432.40,,3000,100,,,case rate,pays based on per visit rate,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5148.6,60,,4118.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,7293.85,85,,5835.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,6006.7,70,,4805.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,7293.85,
"REP ANT ABD HERNIA, ANY AP, TOT DEF < 3C",6936619,CDM,360,RC,49595,HCPCS,OUTPATIENT,,,8581.00,3432.40,,3000,100,,,case rate,pays based on per visit rate,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5148.6,60,,4118.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,7293.85,85,,5835.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,6006.7,70,,4805.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,32,,2196.74,percent of total billed charges,32% of total billed charges,2745.92,7293.85,
"REP ANT ABD HERNIA, ANY AP,TOT DEF > 10C",6936620,CDM,360,RC,49596,HCPCS,OUTPATIENT,,,12628.00,5051.20,,3000,100,,,case rate,pays based on per visit rate,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7576.8,60,,6061.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,10733.8,85,,8587.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,8839.6,70,,7071.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,3000,10733.8,
INS/REM FB SUBQ TISSUE SMPL,6936621,CDM,360,RC,10120,HCPCS,OUTPATIENT,,,904.00,361.60,,3000,100,,,case rate,pays based on per visit rate,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,542.4,60,,433.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,186.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,768.4,85,,614.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,632.8,70,,506.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,186.95,3000,
"BX/EXCN LYMPH NODES; OPEN, DEEP AXCILLAR",6936622,CDM,360,RC,38525,HCPCS,OUTPATIENT,,,8329.00,3331.60,,3000,100,,,case rate,pays based on per visit rate,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4997.4,60,,3997.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,585.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,7079.65,85,,5663.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,5830.3,70,,4664.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,419,7079.65,
I&D ABSCESS; SIMPLE OR SINGLE,6936623,CDM,360,RC,10060,HCPCS,OUTPATIENT,,,438.00,175.20,,3000,100,,,case rate,pays based on per visit rate,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.8,60,,210.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,155.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,3000,
"EXCN TUMR, SOFT TISS/VASCULAR MALFORM HA",6936624,CDM,360,RC,26113,HCPCS,OUTPATIENT,,,3633.00,1453.20,,3000,100,,,case rate,pays based on per visit rate,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2179.8,60,,1743.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,706.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,3088.05,85,,2470.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,2543.1,70,,2034.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,706.79,3088.05,
REP COMPLEX FCCMNAGHF; 2.6-7.5 CM,6936625,CDM,360,RC,13132,HCPCS,OUTPATIENT,,,1408.00,563.20,,3000,100,,,case rate,pays based on per visit rate,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,844.8,60,,675.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,595.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,1196.8,85,,957.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,985.6,70,,788.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,450.56,32,,360.45,percent of total billed charges,32% of total billed charges,450.56,3000,
"LIGATION  OF BIOPSY,  TEMPORAL ARTERY",6936626,CDM,360,RC,37609,HCPCS,OUTPATIENT,,,3633.00,1453.20,,3000,100,,,case rate,pays based on per visit rate,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2179.8,60,,1743.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,404.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,3088.05,85,,2470.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,2543.1,70,,2034.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,404.81,3088.05,
"LARYNGOSCOPY, FLEXIBLE; WITH BIOPSY(IES)",6936627,CDM,360,RC,31576,HCPCS,OUTPATIENT,,,3873.00,1549.20,,3000,100,,,case rate,pays based on per visit rate,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2323.8,60,,1859.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,336.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,3292.05,85,,2633.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,2711.1,70,,2168.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,1239.36,32,,991.49,percent of total billed charges,32% of total billed charges,336.93,3292.05,
"BIOPSY BREAST, W/PLACEMNT OF BRST LOCAT",6936628,CDM,360,RC,19081,HCPCS,OUTPATIENT,,,3633.00,1453.20,,3000,100,,,case rate,pays based on per visit rate,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2179.8,60,,1743.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,638.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,3088.05,85,,2470.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,2543.1,70,,2034.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,638.85,3088.05,
REP ANORECTAL FISTULA /PLUG (SIS),6936629,CDM,360,RC,46707,HCPCS,OUTPATIENT,,,6225.00,2490.00,,3000,100,,,case rate,pays based on per visit rate,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3735,60,,2988,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,668.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,5291.25,85,,4233,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,4357.5,70,,3486,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,668.21,5291.25,
EXCISION; TROCHANTERIC BURSA OR CALCIFIC,6936630,CDM,360,RC,27062,HCPCS,OUTPATIENT,,,7212.00,2884.80,,3000,100,,,case rate,pays based on per visit rate,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,674,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4327.2,60,,3461.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,592.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,6130.2,85,,4904.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,5048.4,70,,4038.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,592.06,6130.2,
MASTERCTOMY SIMPLE AND COMPLETE,6936631,CDM,360,RC,19303,HCPCS,OUTPATIENT,,,14399.00,5759.60,,3000,100,,,case rate,pays based on per visit rate,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,8639.4,60,,6911.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1281.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,12239.15,85,,9791.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,10079.3,70,,8063.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,4607.68,32,,3686.14,percent of total billed charges,32% of total billed charges,591,12239.15,
"COLECTOMY, PARTIAL W/ANASTOMOSIS",6936632,CDM,360,RC,44140,HCPCS,OUTPATIENT,,,7250.00,2900.00,,3000,100,,,case rate,pays based on per visit rate,2320,32,,1856,percent of total billed charges,32% of total billed charges,2320,32,,1856,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4350,60,,3480,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1794.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,6162.5,85,,4930,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,2320,32,,1856,percent of total billed charges,32% of total billed charges,5075,70,,4060,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,2320,32,,1856,percent of total billed charges,32% of total billed charges,1794.81,6162.5,
"COLECTOMY, PARTIAL W/REM TERM ILEUM W/IL",6936633,CDM,360,RC,44160,HCPCS,OUTPATIENT,,,7250.00,2900.00,,3000,100,,,case rate,pays based on per visit rate,2320,32,,1856,percent of total billed charges,32% of total billed charges,2320,32,,1856,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4350,60,,3480,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1656.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,6162.5,85,,4930,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,2320,32,,1856,percent of total billed charges,32% of total billed charges,5075,70,,4060,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2320,32,,1856,percent of total billed charges,32% of total billed charges,2320,32,,1856,percent of total billed charges,32% of total billed charges,1656.71,6162.5,
"OSTECTOMY, COMP EXCISION: OTHER MEDATARS",6936634,CDM,360,RC,28112,HCPCS,OUTPATIENT,,,7212.00,2884.80,,3000,100,,,case rate,pays based on per visit rate,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4327.2,60,,3461.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,604.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,6130.2,85,,4904.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,5048.4,70,,4038.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,479,6130.2,
EXCISIONS THROMBOSED HEMORRHOIDS EXT,6936635,CDM,360,RC,46320,HCPCS,OUTPATIENT,,,2624.00,1049.60,,3000,100,,,case rate,pays based on per visit rate,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1574.4,60,,1259.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,272.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,2230.4,85,,1784.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,272.73,3000,
"REVISION OF TSA, INC ALLOGRAFT WHEN PERF",6936636,CDM,360,RC,23473,HCPCS,OUTPATIENT,,,4219.00,1687.60,,3000,100,,,case rate,pays based on per visit rate,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2531.4,60,,2025.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2110.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,3586.15,85,,2868.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,2953.3,70,,2362.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,1350.08,3586.15,
ATHRO/ASP/INJ SMALL JOINT OR BURSA W/O G,6936637,CDM,360,RC,20600,HCPCS,OUTPATIENT,,,659.00,263.60,,3000,100,,,case rate,pays based on per visit rate,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.4,60,,316.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,560.15,85,,448.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,461.3,70,,369.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,210.88,32,,168.7,percent of total billed charges,32% of total billed charges,67.44,3000,
BX/EXCN LYMPH NODE(S); OPEN INGUINOFEMRO,6936638,CDM,360,RC,38531,HCPCS,OUTPATIENT,,,8329.00,3331.60,,3000,100,,,case rate,pays based on per visit rate,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4997.4,60,,3997.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,590.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,7079.65,85,,5663.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,5830.3,70,,4664.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,2665.28,32,,2132.22,percent of total billed charges,32% of total billed charges,590.86,7079.65,
SURG PREP OR CREATION OF RECIPIENT SITE,6936639,CDM,360,RC,15002,HCPCS,OUTPATIENT,,,4181.00,1672.40,,3000,100,,,case rate,pays based on per visit rate,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2508.6,60,,2006.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,446.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,3553.85,85,,2843.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,2926.7,70,,2341.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,1337.92,32,,1070.34,percent of total billed charges,32% of total billed charges,419,3553.85,
EXPLORATION OF PENETRATING WOULD (SEPERA,6936640,CDM,360,RC,20103,HCPCS,OUTPATIENT,,,3633.00,1453.20,,3000,100,,,case rate,pays based on per visit rate,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2179.8,60,,1743.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,723.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,3088.05,85,,2470.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,2543.1,70,,2034.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,723.81,3088.05,
"EXCN HYDROCELE SPERMATIC CORD, UNILAT",6936641,CDM,360,RC,55500,HCPCS,OUTPATIENT,,,7765.00,3106.00,,3000,100,,,case rate,pays based on per visit rate,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4659,60,,3727.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,507.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,6600.25,85,,5280.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,5435.5,70,,4348.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,2484.8,32,,1987.84,percent of total billed charges,32% of total billed charges,479,6600.25,
BX VAGINAL MUCOSA; SIMPLE (SEPARATE PROC,6936642,CDM,360,RC,57100,HCPCS,OUTPATIENT,,,1704.00,681.60,,3000,100,,,case rate,pays based on per visit rate,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1022.4,60,,817.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,133.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,1192.8,70,,954.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,133.38,3000,
"EXCN B9 LESION W/MARGINS, SNHFG LSN .6-",6936643,CDM,360,RC,11421,HCPCS,OUTPATIENT,,,1704.00,681.60,,3000,100,,,case rate,pays based on per visit rate,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1022.4,60,,817.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,201.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,1192.8,70,,954.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,545.28,32,,436.22,percent of total billed charges,32% of total billed charges,201.28,3000,
"EXCISION OF LESION, TENDON, TENDON SHEAT",6936644,CDM,360,RC,28090,HCPCS,OUTPATIENT,,,3475.00,1390.00,,3000,100,,,case rate,pays based on per visit rate,1112,32,,889.6,percent of total billed charges,32% of total billed charges,1112,32,,889.6,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2085,60,,1668,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,579.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,2953.75,85,,2363,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,1112,32,,889.6,percent of total billed charges,32% of total billed charges,2432.5,70,,1946,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,1112,32,,889.6,percent of total billed charges,32% of total billed charges,479,3000,
HALLUX RIGIDUS CORRECTION WITH CHEILECTO,6936645,CDM,360,RC,28289,HCPCS,OUTPATIENT,,,7212.00,2884.80,,3000,100,,,case rate,pays based on per visit rate,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4327.2,60,,3461.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,861.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,6130.2,85,,4904.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,5048.4,70,,4038.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,479,6130.2,
"EXCN B9 LESN INC MARGINS, EX SKIN TAG,",6936646,CDM,360,RC,11422,HCPCS,OUTPATIENT,,,3633.00,1453.20,,3000,100,,,case rate,pays based on per visit rate,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2179.8,60,,1743.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,226.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,3088.05,85,,2470.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,2543.1,70,,2034.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,226.25,3088.05,
REP INTM WNDS NHF AND/OR G; 2.5 CM-LESS,6936647,CDM,360,RC,12041,HCPCS,OUTPATIENT,,,904.00,361.60,,3000,100,,,case rate,pays based on per visit rate,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,542.4,60,,433.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,333.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,768.4,85,,614.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,632.8,70,,506.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,289.28,32,,231.42,percent of total billed charges,32% of total billed charges,289.28,3000,
"PLEURAL DRAIN, PERC, W/INST IND CATH W/O",6936648,CDM,360,RC,32556,HCPCS,OUTPATIENT,,,4219.00,1687.60,,3000,100,,,case rate,pays based on per visit rate,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2531.4,60,,2025.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,948.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,3586.15,85,,2868.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,2953.3,70,,2362.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,1350.08,32,,1080.06,percent of total billed charges,32% of total billed charges,948.1,3586.15,
LAP SURG; W/RETROPERIT LYMPH NODE SAM S,6936649,CDM,360,RC,38570,HCPCS,OUTPATIENT,,,12628.00,5051.20,,3000,100,,,case rate,pays based on per visit rate,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,1500,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,7576.8,60,,6061.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,672.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,10733.8,85,,8587.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,8839.6,70,,7071.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,4040.96,32,,3232.77,percent of total billed charges,32% of total billed charges,672.98,10733.8,
"EXC B9 LESN, W/MARG, EXCPT SKN TAGS, DIA",6936650,CDM,360,RC,11424,HCPCS,OUTPATIENT,,,3633.00,1453.20,,3000,100,,,case rate,pays based on per visit rate,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2179.8,60,,1743.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,297.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,3088.05,85,,2470.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,2543.1,70,,2034.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,297.98,3088.05,
"SUR TX, SUB Q ANAL FISTULA, SUB Q",6936651,CDM,360,RC,46270,HCPCS,OUTPATIENT,,,6225.00,2490.00,,3000,100,,,case rate,pays based on per visit rate,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3735,60,,2988,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,691.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,5291.25,85,,4233,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,4357.5,70,,3486,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,1992,32,,1593.6,percent of total billed charges,32% of total billed charges,479,5291.25,
"TENOTOMY, SHOULDER AREA; SINGLE TENDON",6936652,CDM,360,RC,23405,HCPCS,OUTPATIENT,,,16026.00,6410.40,,3000,100,,,case rate,pays based on per visit rate,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9615.6,60,,7692.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,805.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,13622.1,85,,10897.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,11218.2,70,,8974.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,5128.32,32,,4102.66,percent of total billed charges,32% of total billed charges,419,13622.1,
"EXCN MALIG LSION W/MARG, TAL EXC D 2.1-3",6936653,CDM,360,RC,11603,HCPCS,OUTPATIENT,,,1572.00,628.80,,3000,100,,,case rate,pays based on per visit rate,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,943.2,60,,754.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,350.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,1336.2,85,,1068.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,1100.4,70,,880.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,350.03,3000,
EXCN OF PILONIDAL CYST/SINUS; EXTENSIVE,6936654,CDM,360,RC,11771,HCPCS,OUTPATIENT,,,6259.00,2503.60,,3000,100,,,case rate,pays based on per visit rate,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3755.4,60,,3004.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,818.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,5320.15,85,,4256.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,4381.3,70,,3505.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,479,5320.15,
AMPUTATION TOE INTERPHALANGEAL JOINT,6936655,CDM,360,RC,28825,HCPCS,OUTPATIENT,,,7212.00,2884.80,,3000,100,,,case rate,pays based on per visit rate,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4327.2,60,,3461.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,372.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,6130.2,85,,4904.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,5048.4,70,,4038.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,2307.84,32,,1846.27,percent of total billed charges,32% of total billed charges,372.99,6130.2,
"DESTRUCTION OF LESIONS, ANUS, SIMPLE; EL",6936656,CDM,360,RC,46910,HCPCS,OUTPATIENT,,,4313.00,1725.20,,3000,100,,,case rate,pays based on per visit rate,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2587.8,60,,2070.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,336.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,3666.05,85,,2932.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,3019.1,70,,2415.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,1380.16,32,,1104.13,percent of total billed charges,32% of total billed charges,336.64,3666.05,
"EXCISION, INTERDIGITAL NEUROMA, SNGL, EA",6936657,CDM,360,RC,28080,HCPCS,OUTPATIENT,,,3475.00,1390.00,,3000,100,,,case rate,pays based on per visit rate,1112,32,,889.6,percent of total billed charges,32% of total billed charges,1112,32,,889.6,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2085,60,,1668,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,663.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,2953.75,85,,2363,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,1112,32,,889.6,percent of total billed charges,32% of total billed charges,2432.5,70,,1946,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1112,32,,889.6,percent of total billed charges,32% of total billed charges,1112,32,,889.6,percent of total billed charges,32% of total billed charges,479,3000,
"REMOVAL OF FOREIGN BODY, FOOT; SUBQ",6936658,CDM,360,RC,28190,HCPCS,OUTPATIENT,,,1572.00,628.80,,3000,100,,,case rate,pays based on per visit rate,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,943.2,60,,754.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,303.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,1336.2,85,,1068.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,1100.4,70,,880.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,503.04,32,,402.43,percent of total billed charges,32% of total billed charges,303.26,3000,
"EXCN TUMOR, SFT TISS, UP ARM/ELBOW 3CM >",6936659,CDM,360,RC,24071,HCPCS,OUTPATIENT,,,6259.00,2503.60,,3000,100,,,case rate,pays based on per visit rate,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3755.4,60,,3004.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,534.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,5320.15,85,,4256.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,4381.3,70,,3505.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,2002.88,32,,1602.3,percent of total billed charges,32% of total billed charges,534.61,5320.15,
"TOTAL ABD HYSTERECTOMY W/WO REM TUBES,OV",6936660,CDM,360,RC,58150,HCPCS,OUTPATIENT,,,14600.00,5840.00,,3000,100,,,case rate,pays based on per visit rate,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8760,60,,7008,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1327.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,12410,85,,9928,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,10220,70,,8176,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,4672,32,,3737.6,percent of total billed charges,32% of total billed charges,1327.83,12410,
I&D ISHIORECTAL/PERI&D RECTAL ABSCESS (S,6936661,CDM,360,RC,46040,HCPCS,OUTPATIENT,,,2624.00,1049.60,,3000,100,,,case rate,pays based on per visit rate,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1574.4,60,,1259.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,721.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,2230.4,85,,1784.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,839.68,32,,671.74,percent of total billed charges,32% of total billed charges,479,3000,
ENTEROLYSIS (FREE ABD ADHESIONS)(SEPARAT,6936662,CDM,360,RC,44005,HCPCS,OUTPATIENT,,,7597.00,3038.80,,3000,100,,,case rate,pays based on per visit rate,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4558.2,60,,3646.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1465.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,6457.45,85,,5165.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,5317.9,70,,4254.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,2431.04,32,,1944.83,percent of total billed charges,32% of total billed charges,1465.69,6457.45,
"BREAST BX, W/PLACE OF LOC DEVICE OR IMG",6936663,CDM,360,RC,19082,HCPCS,OUTPATIENT,,,1817.00,726.80,,3000,100,,,case rate,pays based on per visit rate,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.2,60,,872.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,496.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,1544.45,85,,1235.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,1271.9,70,,1017.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,581.44,32,,465.15,percent of total billed charges,32% of total billed charges,496.24,3000,
REMOVE FB FOOT; DEEP,6936664,CDM,360,RC,28192,HCPCS,OUTPATIENT,,,3633.00,1453.20,,3000,100,,,case rate,pays based on per visit rate,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2179.8,60,,1743.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,574.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,3088.05,85,,2470.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,2543.1,70,,2034.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,1162.56,32,,930.05,percent of total billed charges,32% of total billed charges,419,3088.05,
REP. INT. WNDS FEENL AND/OR MM: 2.6 CM T,6936665,CDM,360,RC,12052,HCPCS,OUTPATIENT,,,903.85,361.54,,3000,100,,,case rate,pays based on per visit rate,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,542.31,60,,433.85,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,397.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,768.27,85,,614.62,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,632.7,70,,506.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,3000,
"EXCN B-9 LES INCLUD, M, W/O SKIN TAG,SNH",6936666,CDM,360,RC,12052,HCPCS,OUTPATIENT,,,903.85,361.54,,3000,100,,,case rate,pays based on per visit rate,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,542.31,60,,433.85,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,397.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,768.27,85,,614.62,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,632.7,70,,506.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,32,,231.38,percent of total billed charges,32% of total billed charges,289.23,3000,
"EXCN LIP; FULL THICKNESS, RECON W/L FLAP",6936667,CDM,360,RC,40525,HCPCS,OUTPATIENT,,,7432.00,2972.80,,3000,100,,,case rate,pays based on per visit rate,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4459.2,60,,3567.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,708.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,6317.2,85,,5053.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,5202.4,70,,4161.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,2378.24,32,,1902.59,percent of total billed charges,32% of total billed charges,419,6317.2,
"REV TOT KNEE ARTHRO, W/WO ALLO; 1 COMP",6936668,CDM,360,RC,27486,HCPCS,OUTPATIENT,,,4024.00,1609.60,,3000,100,,,case rate,pays based on per visit rate,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2414.4,60,,1931.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1836.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,3420.4,85,,2736.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,2816.8,70,,2253.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,1287.68,32,,1030.14,percent of total billed charges,32% of total billed charges,1287.68,3420.4,
"REP, INT WNDS OF NHF A/O EXT GEN 2.6-7.5",6936669,CDM,360,RC,12042,HCPCS,OUTPATIENT,,,920.45,368.18,,3000,100,,,case rate,pays based on per visit rate,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,552.27,60,,441.82,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,390.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,782.38,85,,625.9,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,644.32,70,,515.46,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,294.54,32,,235.63,percent of total billed charges,32% of total billed charges,294.54,3000,
REP RUPTURED MUSCULOTENDINOUS CUFF OPEN;,6936670,CDM,360,RC,23412,HCPCS,OUTPATIENT,,,16514.00,6605.60,,3000,100,,,case rate,pays based on per visit rate,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,935,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9908.4,60,,7926.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1111.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,14036.9,85,,11229.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,11559.8,70,,9247.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,935,14036.9,
"OPEN TX CROMIOCLAVICULAR DISLO, ACUTE/CH",6936672,CDM,360,RC,23550,HCPCS,OUTPATIENT,,,16514.00,6605.60,,3000,100,,,case rate,pays based on per visit rate,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,9908.4,60,,7926.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,744.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,14036.9,85,,11229.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,11559.8,70,,9247.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,5284.48,32,,4227.58,percent of total billed charges,32% of total billed charges,479,14036.9,
"COLONSCOPY, FLEXIBLE; W/REM OF FOREIGN B",6936673,CDM,360,RC,45379,HCPCS,OUTPATIENT,,,2724.00,1089.60,,3000,100,,,case rate,pays based on per visit rate,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1634.4,60,,1307.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,560.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,2315.4,85,,1852.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,1906.8,70,,1525.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,871.68,32,,697.34,percent of total billed charges,32% of total billed charges,419,3000,
BANDAGE COVERLET 2X4 STRIPS,7100034,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
BIOPSY TRAY (BASIC),7100060,CDM,272,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CATH FOLEY 14FR 5CC,7100091,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LIL-KITCH PUC PED STER,7100232,CDM,271,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
NEEDLE BIOPSY 14GAX4 1/2,7100283,CDM,272,RC,,,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
POUCH SURFIT 1 1/4,7100339,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
RUTNER UNIVERSAL WEDGE CATHETER,7100357,CDM,272,RC,,,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
SET EXT 20  L NO CLAMP,7100363,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SOF-FLEX DOUBLE PIGTAIL STENT SET,7100369,CDM,272,RC,,,OUTPATIENT,,,287.00,114.80,,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.2,60,,137.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.8,40,,91.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,200.9,70,,160.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,243.95,
ST.POLYDERM HYDRO DSG 4x4,7100393,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
L&D OBVS SIMPLE-PER HR,8000138,CDM,720,RC,99218,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,101.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,101.25,
LD OBVS COMPLEX-PER HR,8000139,CDM,720,RC,99220,HCPCS,OUTPATIENT,,,191.00,76.40,,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.6,60,,91.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,224.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,224.75,
LD OBVS FIRST HOUR,8000140,CDM,762,RC,99219,HCPCS,OUTPATIENT,,,268.00,107.20,,1500,100,,,case rate,pays based on per visit rate,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,60,,128.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,166.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,1500,
LD OBVS EACH ADD'L HOUR,8000141,CDM,762,RC,99219,HCPCS,OUTPATIENT,,,43.00,17.20,,1500,100,,,case rate,pays based on per visit rate,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,1500,
LD OBVS FIRST HR/SAME DAY ADMIT/DISC,8000235,CDM,762,RC,99235,HCPCS,OUTPATIENT,,,268.00,107.20,,1500,100,,,case rate,pays based on per visit rate,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,60,,128.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,207.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,1500,
LD OBVS ADD'L HR/SAME DAY ADMIT/DISC,8000236,CDM,762,RC,99235,HCPCS,OUTPATIENT,,,43.00,17.20,,1500,100,,,case rate,pays based on per visit rate,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,1500,
LD AMNIOCENTESIS: DIAGNOSTIC,8004550,CDM,360,RC,59000,HCPCS,OUTPATIENT,,,229.00,91.60,,3000,100,,,case rate,pays based on per visit rate,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.4,60,,109.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,151.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,160.3,70,,128.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,3000,
LD FETAL MONITOR,8004554,CDM,271,RC,,,OUTPATIENT,,,238.00,95.20,,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.8,60,,114.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,166.6,70,,133.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,202.3,
LD AMNIOCENTESIS; THERAPEUTIC FLUID RED,8004555,CDM,360,RC,59001,HCPCS,OUTPATIENT,,,229.00,91.60,,3000,100,,,case rate,pays based on per visit rate,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.4,60,,109.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,239.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,160.3,70,,128.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,3000,
"LD TRANSABDOMINAL AMNIOINFUSION,W/US GUI",8004559,CDM,360,RC,59070,HCPCS,OUTPATIENT,,,229.00,91.60,,3000,100,,,case rate,pays based on per visit rate,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.4,60,,109.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,286.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,160.3,70,,128.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,3000,
"LD NON-STRESS TEST, FETAL",8004560,CDM,482,RC,59025,HCPCS,OUTPATIENT,,,229.00,91.60,,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,136,272,,,fee schedule,272% of BCBS fee schedule,136,272,,,fee schedule,272% of BCBS fee schedule,136,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,137.4,60,,109.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,160.3,70,,128.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,23.76,194.65,
"LD STRESS TEST, FETAL CONTRACTION",8004565,CDM,482,RC,59020,HCPCS,OUTPATIENT,,,229.00,91.60,,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,253.64,272,,,fee schedule,272% of BCBS fee schedule,253.64,272,,,fee schedule,272% of BCBS fee schedule,253.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,137.4,60,,109.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,160.3,70,,128.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,40.43,253.64,
LD TREATMENT ROOM,8004570,CDM,761,RC,59000,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,97.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,97.5,
LD TOCOLYSIS,8004575,CDM,761,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
LD ANCILLARY CHG LABOR/DELIVERLY PER HR,8004580,CDM,721,RC,,,OUTPATIENT,,,204.00,81.60,,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.4,60,,97.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,173.4,
LD VENIPUNCTURE,8036415,CDM,720,RC,36415,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,8.16,
"LD CIRCUMCISION, USING CLAMP",8054150,CDM,723,RC,54150,HCPCS,OUTPATIENT,,,1336.00,534.40,,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,801.6,60,,641.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,1135.6,85,,908.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,935.2,70,,748.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,189.91,1135.6,
"LD CIRCUMCISION, OTHER THAN CLAMP",8054160,CDM,723,RC,54150,HCPCS,OUTPATIENT,,,1336.00,534.40,,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,801.6,60,,641.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,1135.6,85,,908.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,935.2,70,,748.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,427.52,32,,342.02,percent of total billed charges,32% of total billed charges,189.91,1135.6,
LD FETAL MONITORING BY PHYS,8059050,CDM,731,RC,59050,HCPCS,OUTPATIENT,,,226.00,90.40,,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.6,60,,108.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,67.83,192.1,
"LD INJECTIONS, THERAPEUTIC",8090782,CDM,450,RC,90782,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
"LD INJECTION, IV",8090784,CDM,450,RC,96374,HCPCS,OUTPATIENT,,,148.00,59.20,,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,60,,71.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,103.6,70,,82.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,125.8,
"LD INJECTION, IM",8090788,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,148.00,59.20,,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,60,,71.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,103.6,70,,82.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,17.71,125.8,
LD TELEMETRY,8093012,CDM,732,RC,93012,HCPCS,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,147.05,
LD HOLTER MONITOR,8093225,CDM,731,RC,93225,HCPCS,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,272.14,272,,,fee schedule,272% of BCBS fee schedule,272.14,272,,,fee schedule,272% of BCBS fee schedule,272.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,23.36,272.14,
WOUND CLOSURE UTALIZING TISS ADH(ONLY),11000168,CDM,450,RC,G0168,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,92.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,92.5,
OPT VST SPEC COLLECT SARS-COVID 19 ANY S,11009803,CDM,450,RC,C9803,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
ED I & D ABCESS-SIMPLE,11010060,CDM,450,RC,10060,HCPCS,OUTPATIENT,,,308.00,123.20,,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,60,,147.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,155.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,261.8,
ED I & D ABCESS-COMPLICATED,11010061,CDM,450,RC,10061,HCPCS,OUTPATIENT,,,697.00,278.80,,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.2,60,,334.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,270.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,487.9,70,,390.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,32,,178.43,percent of total billed charges,32% of total billed charges,223.04,592.45,
ED I & D-PHILONIDAL CYST-SIMPLE,11010080,CDM,450,RC,10080,HCPCS,OUTPATIENT,,,308.00,123.20,,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,60,,147.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,320.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,320.68,
ED FB REMO-SUBCUTANEOUS-SIMPLE,11010120,CDM,450,RC,10120,HCPCS,OUTPATIENT,,,698.00,279.20,,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.8,60,,335.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,186.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,488.6,70,,390.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,186.95,593.3,
ED FB REMO-SUBCUTANEOUS-COMPLICAT,11010121,CDM,450,RC,10121,HCPCS,OUTPATIENT,,,3200.00,1280.00,,,,,,other ,not seperately reimbursable,1024,32,,819.2,percent of total billed charges,32% of total billed charges,1024,32,,819.2,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1920,60,,1536,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,336.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1024,32,,819.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1024,32,,819.2,percent of total billed charges,32% of total billed charges,2720,85,,2176,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1024,32,,819.2,percent of total billed charges,32% of total billed charges,1024,32,,819.2,percent of total billed charges,32% of total billed charges,2240,70,,1792,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1024,32,,819.2,percent of total billed charges,32% of total billed charges,1024,32,,819.2,percent of total billed charges,32% of total billed charges,336.08,2720,
ED I & D HEMATOMA-SIMPLE,11010140,CDM,450,RC,10140,HCPCS,OUTPATIENT,,,2131.00,852.40,,,,,,other ,not seperately reimbursable,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1278.6,60,,1022.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,214.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,1811.35,85,,1449.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,681.92,32,,545.54,percent of total billed charges,32% of total billed charges,214.61,1811.35,
ED I & D ASPIRATION OF ABCESS,11010160,CDM,450,RC,10160,HCPCS,OUTPATIENT,,,698.00,279.20,,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.8,60,,335.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,162.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,488.6,70,,390.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,162.28,593.3,
ED DEBRI OF ECZEMATOUS 10% OF BOD,11011000,CDM,450,RC,11000,HCPCS,OUTPATIENT,,,970.00,388.00,,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,72.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,72.93,824.5,
DEBRIDE SQ TISS 1ST 20 SQ CM OR<,11011040,CDM,450,RC,11042,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,162.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,419,
DEBRIDE MUSCLE/FASCIA 1ST 20 SQ CM OR<,11011041,CDM,450,RC,11043,HCPCS,OUTPATIENT,,,970.00,388.00,,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,297,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,297,824.5,
DEB/REM FM OF OPN FXDISLO SKIN TO BONE,11011042,CDM,450,RC,11012,HCPCS,OUTPATIENT,,,5278.00,2111.20,,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3166.8,60,,2533.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,833.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,4486.3,85,,3589.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,3694.6,70,,2955.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,1688.96,32,,1351.17,percent of total billed charges,32% of total billed charges,419,4486.3,
"ED BIOPSY OF SKIN,SUB TISSUE/MUCOS",11011044,CDM,450,RC,11100,HCPCS,OUTPATIENT,,,510.00,204.00,,,,,,other ,not seperately reimbursable,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306,60,,244.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,433.5,85,,346.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,357,70,,285.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,163.2,32,,130.56,percent of total billed charges,32% of total billed charges,163.2,433.5,
"RMVL OF SKIN TAG, UP TO 15",11011200,CDM,450,RC,11200,HCPCS,OUTPATIENT,,,379.00,151.60,,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.4,60,,181.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,265.3,70,,212.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,112.54,322.15,
ED WND RP-SIMP-hd/nk/ha/ft/gn 7.6-12.5CM,11011204,CDM,450,RC,12004,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,168.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMP-SNAGTE 7.6-12.5 CM,11011205,CDM,450,RC,12004,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,168.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMP-SNAGTE 20.1-30.0 CM,11011206,CDM,450,RC,12006,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,267,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-SIMPLE SNAGTE >30 CM,11011207,CDM,450,RC,12007,HCPCS,OUTPATIENT,,,839.00,335.60,,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,503.4,60,,402.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,301.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,713.15,85,,570.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,587.3,70,,469.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,713.15,
ED WND RP-SIMP-SNAGTE 2.5CMOR<,11011221,CDM,450,RC,12001,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMP-SNAGTE 2.6-7.5 CM,11011222,CDM,450,RC,12002,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
"ED EXCISION, BENIGN LESION DIA 0.6/1.0cm",11011401,CDM,450,RC,11401,HCPCS,OUTPATIENT,,,698.00,279.20,,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.8,60,,335.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,196.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,488.6,70,,390.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,223.36,32,,178.69,percent of total billed charges,32% of total billed charges,196.71,593.3,
EXC B9 LESION TRNK ARMS LEGS 2.1-3.0 CM,11011403,CDM,450,RC,11403,HCPCS,OUTPATIENT,,,1354.00,541.60,,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,812.4,60,,649.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,249.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,1150.9,85,,920.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,947.8,70,,758.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,249.46,1150.9,
ER EXCISION BENIGN LESION 0.5CM OF LESS,11011420,CDM,450,RC,11420,HCPCS,OUTPATIENT,,,1286.00,514.40,,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,159.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,159.61,1093.1,
ED NAILS-AVUISION-SIMPLE,11011730,CDM,450,RC,11730,HCPCS,OUTPATIENT,,,208.00,83.20,,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,60,,99.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,145.6,70,,116.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,176.8,
ED NAILS-SIMPLE EA  ADDL NAIL PLATE,11011732,CDM,450,RC,11732,HCPCS,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,42.48,115.6,
ED NAILS-EVACUAT SUBUNGUAL HEMATO,11011740,CDM,450,RC,11740,HCPCS,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,70.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
ED REMOVAL OF NAIL,11011750,CDM,450,RC,11750,HCPCS,OUTPATIENT,,,757.00,302.80,,,,,,other ,not seperately reimbursable,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,454.2,60,,363.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,200.09,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,643.45,85,,514.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,529.9,70,,423.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,242.24,32,,193.79,percent of total billed charges,32% of total billed charges,200.09,643.45,
ED NAILS-NAILBED RECONSTRUCTION,11011760,CDM,450,RC,11760,HCPCS,OUTPATIENT,,,970.00,388.00,,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,237.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,237.28,824.5,
ED EXCISION NAIL BED FOLD,11011765,CDM,450,RC,11765,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,206.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
ED WND RP-SIMPLE-TRUNK UP TO 2.5C,11012001,CDM,450,RC,12001,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-TRUND 2.6-7.5CM,11012002,CDM,450,RC,12002,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-TRUNK 7.6-12.5CM,11012004,CDM,450,RC,12004,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,168.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-TRUNK 12.6-20.0C,11012005,CDM,450,RC,12005,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-SIMPLE-TRUNK 20.1-30.0C,11012006,CDM,450,RC,12006,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,267,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-SIMPLE-SNAGTE >30 CM,11012007,CDM,450,RC,12007,HCPCS,OUTPATIENT,,,839.00,335.60,,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,503.4,60,,402.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,301.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,713.15,85,,570.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,587.3,70,,469.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,713.15,
ED WND RP-SIMPLE-FACE MEM TO 2.5C,11012011,CDM,450,RC,12011,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-FACE MEM 2.6-5.0,11012013,CDM,450,RC,12013,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,150.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-FACE MEM 5.1-7.5,11012014,CDM,450,RC,12014,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,184.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-FAC MEM 7.6-12.5,11012015,CDM,450,RC,12015,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,221.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-FAC MEM 12.6 cm - 20 cm,11012016,CDM,450,RC,12016,HCPCS,OUTPATIENT,,,761.00,304.40,,,,,,other ,not seperately reimbursable,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,456.6,60,,365.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,284.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,646.85,85,,517.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,532.7,70,,426.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,243.52,32,,194.82,percent of total billed charges,32% of total billed charges,243.52,646.85,
ED WND RP-SIMPLE-FAC MEM 20.1 cm - 30 cm,11012017,CDM,450,RC,12017,HCPCS,OUTPATIENT,,,876.00,350.40,,,,,,other ,not seperately reimbursable,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,525.6,60,,420.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,205.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,744.6,85,,595.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,613.2,70,,490.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,280.32,32,,224.26,percent of total billed charges,32% of total billed charges,205.74,744.6,
ED WND RP-SIMPLE-FAC MEM> 30 cm,11012018,CDM,450,RC,12018,HCPCS,OUTPATIENT,,,1034.00,413.60,,,,,,other ,not seperately reimbursable,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,620.4,60,,496.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,234.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,878.9,85,,703.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,723.8,70,,579.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,330.88,32,,264.7,percent of total billed charges,32% of total billed charges,234.01,878.9,
ED WND PR-INT-S/A/T/E 2.5 CM OR<,11012031,CDM,450,RC,12031,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,331.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,331.53,
ED WND PR-INT S/A/T/E 2.6-7.5 CM,11012032,CDM,450,RC,12032,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,379.23,
ED WND RP-INT -S/A/T/E 7.6-12.5 CM,11012034,CDM,450,RC,12034,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,405,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-INT -S/A/T/E 12.6-20 CM,11012035,CDM,450,RC,12035,HCPCS,OUTPATIENT,,,720.00,288.00,,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,432,60,,345.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,496.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,504,70,,403.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,612,
ED WND RP-INT S/A/T/E 20.1-30.0 CM,11012036,CDM,450,RC,12036,HCPCS,OUTPATIENT,,,682.00,272.80,,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,409.2,60,,327.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,557.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,579.7,85,,463.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,477.4,70,,381.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,579.7,
ED WND RP-INT S/A/T/E >30 cm,11012037,CDM,450,RC,12037,HCPCS,OUTPATIENT,,,1566.00,626.40,,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,939.6,60,,751.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,624.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,1331.1,85,,1064.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,1096.2,70,,876.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,419,1331.1,
ED WND RP-INTERMED-HDS FT 2.5CM,11012041,CDM,450,RC,12041,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,333.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,333.01,
ED WND RP-INTERMED-HDS FT 2.6-7.5,11012042,CDM,450,RC,12042,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,390.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,390.76,
ED WND RP-INTERMED-HD FT 7.6-12.5,11012044,CDM,450,RC,12044,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,405,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-INTERMED-HD FT 12.6-20,11012045,CDM,450,RC,12045,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,405,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-INTERMED-20.1CM TO 30. CM,11012046,CDM,450,RC,12046,HCPCS,OUTPATIENT,,,791.00,316.40,,,,,,other ,not seperately reimbursable,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,474.6,60,,379.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,648.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,672.35,85,,537.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,553.7,70,,442.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,253.12,32,,202.5,percent of total billed charges,32% of total billed charges,253.12,672.35,
ED WND RP-INTERMED-hd/nk/ha/ft/gn>30 cm,11012047,CDM,450,RC,12047,HCPCS,OUTPATIENT,,,1548.00,619.20,,,,,,other ,not seperately reimbursable,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,928.8,60,,743.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,710.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,1315.8,85,,1052.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,1083.6,70,,866.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,495.36,32,,396.29,percent of total billed charges,32% of total billed charges,419,1315.8,
ED WND RP-INTERMED-FFACE MEB 2.5CM,11012051,CDM,450,RC,12051,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,357.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,357.63,
ED WND RP-INTER-FACE MEM 2.6-5.0C,11012052,CDM,450,RC,12052,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,397.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,397.9,
ED WND RP-INTER-FACE MEM 5.1-7.5C,11012053,CDM,450,RC,12053,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,405,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,405,
WND RP-INTER-FACE MEM 7.6-12.5,11012054,CDM,450,RC,12054,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,405,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WOUND RP-IMED-EY NO EA 12.6CM -20.0CM,11012055,CDM,450,RC,12055,HCPCS,OUTPATIENT,,,754.00,301.60,,,,,,other ,not seperately reimbursable,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,452.4,60,,361.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,642.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,640.9,85,,512.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,527.8,70,,422.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,241.28,32,,193.02,percent of total billed charges,32% of total billed charges,241.28,642.58,
WND RP-INTER-FACE MEM 20.1 cm-30 cm,11012056,CDM,450,RC,12056,HCPCS,OUTPATIENT,,,1700.00,680.00,,,,,,other ,not seperately reimbursable,544,32,,435.2,percent of total billed charges,32% of total billed charges,544,32,,435.2,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1020,60,,816,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,740.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,544,32,,435.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,544,32,,435.2,percent of total billed charges,32% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,544,32,,435.2,percent of total billed charges,32% of total billed charges,544,32,,435.2,percent of total billed charges,32% of total billed charges,1190,70,,952,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,544,32,,435.2,percent of total billed charges,32% of total billed charges,544,32,,435.2,percent of total billed charges,32% of total billed charges,419,1445,
WND RP-INTER-FACE MEM> 30 cm,11012057,CDM,450,RC,12057,HCPCS,OUTPATIENT,,,1886.00,754.40,,,,,,other ,not seperately reimbursable,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1131.6,60,,905.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,784.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,1603.1,85,,1282.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,1320.2,70,,1056.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,603.52,32,,482.82,percent of total billed charges,32% of total billed charges,419,1603.1,
ED WOUND REPR-COMPLEX-1.1-2.5CM,11013100,CDM,450,RC,13100,HCPCS,OUTPATIENT,,,3193.00,1277.20,,,,,,other ,not seperately reimbursable,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1915.8,60,,1532.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,429.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,2714.05,85,,2171.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,2235.1,70,,1788.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,1021.76,32,,817.41,percent of total billed charges,32% of total billed charges,419,2714.05,
ED WOUND REPR-COMPLEX-2.6-7.5CM,11013101,CDM,450,RC,13101,HCPCS,OUTPATIENT,,,1096.00,438.40,,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,657.6,60,,526.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,501.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,931.6,85,,745.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,767.2,70,,613.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,931.6,
ED WOUND REPR-CMPLX EA ADDNL 5 CM,11013102,CDM,450,RC,13102,HCPCS,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,312,
ED WOUND REPR-SCALP AM LG-1.1-2.5,11013120,CDM,450,RC,13120,HCPCS,OUTPATIENT,,,970.00,388.00,,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,449.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,824.5,
ED WOUND REPR-SCALP AM LG 2.6-7.5,11013121,CDM,450,RC,13121,HCPCS,OUTPATIENT,,,720.00,288.00,,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,432,60,,345.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,535.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,504,70,,403.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,612,
CR SLP/ARM/LG; EA ADD 5CM or <,11013122,CDM,450,RC,13122,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,161.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,312,
ED WOUND REPR-COMPLE-HEAD 1.1-2.5,11013131,CDM,450,RC,13131,HCPCS,OUTPATIENT,,,970.00,388.00,,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,489.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,824.5,
ED WOUND REPR-COMPLE-HEAD 2.6-7.5,11013132,CDM,450,RC,13132,HCPCS,OUTPATIENT,,,720.00,288.00,,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,432,60,,345.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,595.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,504,70,,403.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,612,
ED EACH ADD'L 5CM OR LESS,11013133,CDM,450,RC,13133,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,213.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,312,
ED WOUND RP-COMP-EY NO EA <1.2 CM,11013150,CDM,450,RC,12051,HCPCS,OUTPATIENT,,,685.00,274.00,,,,,,other ,not seperately reimbursable,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411,60,,328.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,357.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,582.25,85,,465.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,479.5,70,,383.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,219.2,32,,175.36,percent of total billed charges,32% of total billed charges,219.2,582.25,
ED WOUND RP-COMP-EY NO EA 1.1-2.5,11013151,CDM,450,RC,13151,HCPCS,OUTPATIENT,,,1096.00,438.40,,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,657.6,60,,526.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,535.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,931.6,85,,745.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,767.2,70,,613.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,931.6,
ED WOUND RP-COMP-EY NO EA 2.6-7.5,11013152,CDM,450,RC,13152,HCPCS,OUTPATIENT,,,859.00,343.60,,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,515.4,60,,412.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,629.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,730.15,85,,584.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,601.3,70,,481.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,730.15,
CR EYELID NOSE EAR LIP EA ADDNL 5 CM,11013153,CDM,450,RC,13153,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,479,
ED SEC CLOSURE OF SURG WOUND EXT OR COMP,11013160,CDM,450,RC,13160,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1033.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,419,2593.35,
ED ATTACHE PEDICLE GRAFT-TRUNK/10 SQ CM,11014000,CDM,450,RC,14000,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,804.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,419,2593.35,
ED ATTCHE PDCL GRFT-TRNK/10.1-30.0 SQ CM,11014001,CDM,450,RC,14001,HCPCS,OUTPATIENT,,,3437.00,1374.80,,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2062.2,60,,1649.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1030.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,2921.45,85,,2337.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,2405.9,70,,1924.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,1099.84,32,,879.87,percent of total billed charges,32% of total billed charges,479,2921.45,
"ED ATTCH PDCL GRFT-SCLP,ARMS,LGS 10SQ CM",11014020,CDM,450,RC,14020,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,882.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,2593.35,
"ED ATTCH PDCL GRFT-SCLP,ARMS,LGS10.1-30.",11014021,CDM,450,RC,14021,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1090.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,2593.35,
"ED ATTCH PDCL GRFT-FRHD,CKS,CHN,MTH 10",11014040,CDM,450,RC,14040,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,952.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,419,2593.35,
"ED ATTCH PDCL GRFT-FRHD,CKS,CHN,10.1-30.",11014041,CDM,450,RC,14041,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1156,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,2593.35,
"ED ATTCH PDCL GRFT-EYE LDS,NOSE,ERS,10.",11014060,CDM,450,RC,14060,HCPCS,OUTPATIENT,,,3521.00,1408.40,,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2112.6,60,,1690.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,964.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2992.85,85,,2394.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2464.7,70,,1971.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,2992.85,
"ED ATTCH PDCL GRFT-EYE LDS,NSE,ER,10.-30",11014061,CDM,450,RC,14061,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1243.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,479,2593.35,
ED ATTCH PDCL GRFT-CPMPLICATED >30.,11014300,CDM,450,RC,14301,HCPCS,OUTPATIENT,,,3051.00,1220.40,,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1830.6,60,,1464.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1378.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2593.35,85,,2074.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,2135.7,70,,1708.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,976.32,32,,781.06,percent of total billed charges,32% of total billed charges,591,2593.35,
SKIN FULL GRFT Face/Gent/HF 20 SQ CM <,11015240,CDM,450,RC,15240,HCPCS,OUTPATIENT,,,2030.00,812.00,,,,,,other ,not seperately reimbursable,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1218,60,,974.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1169.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,1725.5,85,,1380.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,1421,70,,1136.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,649.6,32,,519.68,percent of total billed charges,32% of total billed charges,479,1725.5,
ED BURNS-INITAL VISIT-1ST DEGREE,11016000,CDM,450,RC,16000,HCPCS,OUTPATIENT,,,379.00,151.60,,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.4,60,,181.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,265.3,70,,212.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,96.31,322.15,
ED BURNS/DRESS-SMALL 5%,11016020,CDM,450,RC,16020,HCPCS,OUTPATIENT,,,208.00,83.20,,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,60,,99.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,145.6,70,,116.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,176.8,
ED BURNS/DRESS-MEDIUM 5-10%,11016025,CDM,450,RC,16025,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,200.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,419,
ED BURNS-DRESS-LARGE MORE 10%,11016030,CDM,450,RC,16030,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,312,
ED DESTRUCTION FACIAL LESION/ONE,11017000,CDM,450,RC,17000,HCPCS,OUTPATIENT,,,379.00,151.60,,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.4,60,,181.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,265.3,70,,212.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,121.28,32,,97.02,percent of total billed charges,32% of total billed charges,83.94,322.15,
ED DESTRUCTION LESION UP TO 14,11017010,CDM,450,RC,17110,HCPCS,OUTPATIENT,,,174.00,69.60,,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,140.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,147.9,
"ED CAUTERIZATIO, CHEMICAL",11017250,CDM,450,RC,17250,HCPCS,OUTPATIENT,,,259.00,103.60,,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.4,60,,124.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,220.15,
ED WOUND EXPLORATION-EXTEREMITY,11020103,CDM,450,RC,20103,HCPCS,OUTPATIENT,,,1012.00,404.80,,,,,,other ,not seperately reimbursable,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,607.2,60,,485.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,723.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,860.2,85,,688.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,708.4,70,,566.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,323.84,32,,259.07,percent of total billed charges,32% of total billed charges,323.84,860.2,
ED INJ(S) SINGLE OR MULTI 1OR2 MUSCLES,11020552,CDM,450,RC,20552,HCPCS,OUTPATIENT,,,355.00,142.00,,,,,,other ,not seperately reimbursable,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213,60,,170.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,68.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,301.75,85,,241.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,248.5,70,,198.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,113.6,32,,90.88,percent of total billed charges,32% of total billed charges,68.25,301.75,
INJ SINGL OR MULTI TRIGER POINTS 3 OR >,11020553,CDM,450,RC,20553,HCPCS,OUTPATIENT,,,580.00,232.00,,,,,,other ,not seperately reimbursable,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,348,60,,278.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,78.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,406,70,,324.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,185.6,32,,148.48,percent of total billed charges,32% of total billed charges,78.45,493,
ED ARTH-ASP OR INJ-SMALL JOINT,11020600,CDM,450,RC,20600,HCPCS,OUTPATIENT,,,396.00,158.40,,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.6,60,,190.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,277.2,70,,221.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,67.44,336.6,
ED ARTH ASP OR INJ INTERMED JOINT,11020605,CDM,450,RC,20605,HCPCS,OUTPATIENT,,,549.00,219.60,,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.4,60,,263.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,69.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,69.53,466.65,
ED ARTH ASP OR INJ MAJOR JOINT,11020610,CDM,450,RC,20610,HCPCS,OUTPATIENT,,,396.00,158.40,,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.6,60,,190.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,277.2,70,,221.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,82.64,336.6,
ED ASPIRATION &/OR INJ GANGLION CYST,11020612,CDM,450,RC,20612,HCPCS,OUTPATIENT,,,847.00,338.80,,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,508.2,60,,406.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,719.95,85,,575.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,592.9,70,,474.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,81.16,719.95,
ED CL FRAC WO MAN CL OR OP NASAL,11021310,CDM,450,RC,21310,HCPCS,OUTPATIENT,,,353.00,141.20,,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,211.8,60,,169.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,141.2,40,,112.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,247.1,70,,197.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,419,
ED DISLOCAT CL TM JOINT UNCOMPLIC,11021480,CDM,450,RC,21480,HCPCS,OUTPATIENT,,,353.00,141.20,,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,211.8,60,,169.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,175.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,247.1,70,,197.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,32,,90.37,percent of total billed charges,32% of total billed charges,112.96,312,
ED CL FRAC WO MAN CL RIB UNCOMPL,11021800,CDM,450,RC,21800,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,135.2,40,,108.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,287.3,
EXC TUMR SOFT TISS  BK/FLANK SQ <3 CM,11021930,CDM,450,RC,21930,HCPCS,OUTPATIENT,,,2014.00,805.60,,,,,,other ,not seperately reimbursable,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1208.4,60,,966.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,649.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,1711.9,85,,1369.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,1409.8,70,,1127.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,644.48,32,,515.58,percent of total billed charges,32% of total billed charges,419,1711.9,
ED CL FRAC WO MAN CL CLAVICULAR,11023500,CDM,450,RC,23500,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,286.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,312,
ED DISLOCAT CL AC SEPERAT WO MAN,11023540,CDM,450,RC,23540,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,308.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,312,
ED DISLO/FX W/ MANI ACROMINOCLAVICUL,11023545,CDM,450,RC,23545,HCPCS,OUTPATIENT,,,677.00,270.80,,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,406.2,60,,324.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,454.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,473.9,70,,379.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,575.45,
ED CLSD TRMT PROXIMAL HUNERAL W/MANIPULA,11023605,CDM,450,RC,23605,HCPCS,OUTPATIENT,,,3292.00,1316.80,,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1975.2,60,,1580.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,608.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2798.2,85,,2238.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2304.4,70,,1843.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,419,2798.2,
ED CLSD TX SHOULDER DISLOC W MAN WO ANES,11023650,CDM,450,RC,23650,HCPCS,OUTPATIENT,,,390.00,156.00,,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,424.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,424.66,
ED DISLOCAT REQUIRING ANESTHESIA,11023655,CDM,450,RC,23655,HCPCS,OUTPATIENT,,,1200.00,480.00,,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,531.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,312,1020,
ED CLOSED TREATMENT SHOULDER DISL W/MANI,11023665,CDM,450,RC,23665,HCPCS,OUTPATIENT,,,2481.00,992.40,,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1488.6,60,,1190.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,562.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,2108.85,85,,1687.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,1736.7,70,,1389.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,419,2108.85,
CLOSED TX OF DISTAL RADIAL,11023700,CDM,450,RC,25600,HCPCS,OUTPATIENT,,,636.00,254.40,,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381.6,60,,305.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,433.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,540.6,85,,432.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,445.2,70,,356.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,540.6,
ED INCISION & DRAINAGE UP ARM/ELBOW,11023930,CDM,450,RC,23930,HCPCS,OUTPATIENT,,,2759.00,1103.60,,,,,,other ,not seperately reimbursable,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1655.4,60,,1324.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,464.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,2345.15,85,,1876.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,1931.3,70,,1545.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,882.88,32,,706.3,percent of total billed charges,32% of total billed charges,312,2345.15,
REM FB UPPER ARM/ELBOW SUBQ,11024200,CDM,450,RC,24200,HCPCS,OUTPATIENT,,,3325.00,1330.00,,,,,,other ,not seperately reimbursable,1064,32,,851.2,percent of total billed charges,32% of total billed charges,1064,32,,851.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1995,60,,1596,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,279.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1064,32,,851.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1064,32,,851.2,percent of total billed charges,32% of total billed charges,2826.25,85,,2261,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1064,32,,851.2,percent of total billed charges,32% of total billed charges,1064,32,,851.2,percent of total billed charges,32% of total billed charges,2327.5,70,,1862,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1064,32,,851.2,percent of total billed charges,32% of total billed charges,1064,32,,851.2,percent of total billed charges,32% of total billed charges,279.31,2826.25,
ED CLD TREAT OF HUNERAL FRACTURE W/MAN,11024535,CDM,450,RC,24535,HCPCS,OUTPATIENT,,,1750.00,700.00,,,,,,other ,not seperately reimbursable,560,32,,448,percent of total billed charges,32% of total billed charges,560,32,,448,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1050,60,,840,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,802.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,560,32,,448,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,560,32,,448,percent of total billed charges,32% of total billed charges,1487.5,85,,1190,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,560,32,,448,percent of total billed charges,32% of total billed charges,560,32,,448,percent of total billed charges,32% of total billed charges,1225,70,,980,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,560,32,,448,percent of total billed charges,32% of total billed charges,560,32,,448,percent of total billed charges,32% of total billed charges,312,1487.5,
ED DISLOCAT CL ELBOW W/O ANES,11024600,CDM,450,RC,24600,HCPCS,OUTPATIENT,,,849.00,339.60,,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,509.4,60,,407.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,488.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,721.65,85,,577.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,594.3,70,,475.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,32,,217.34,percent of total billed charges,32% of total billed charges,271.68,721.65,
ED DISLOCAT CL ELBOW NURSE W MAN,11024640,CDM,450,RC,24640,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,131.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,287.3,
ED CLSED REDUCTION W/MAN OF RADIUS,11024655,CDM,450,RC,26700,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,422.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,422.5,
"ARTHRODESIS, ELBOW JOINT; LOCAL;",11024800,CDM,450,RC,24800,HCPCS,OUTPATIENT,,,11242.00,4496.80,,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,6745.2,60,,5396.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1088.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,9555.7,85,,7644.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,7869.4,70,,6295.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,3597.44,32,,2877.95,percent of total billed charges,32% of total billed charges,591,9555.7,
ED CLOSED TREAT RAD SHAFT WO MA,11025500,CDM,450,RC,25500,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,365.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,365.69,
CLSD TX RADIAL FX W/ MANIPULATION,11025505,CDM,450,RC,25505,HCPCS,OUTPATIENT,,,2481.00,992.40,,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1488.6,60,,1190.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,654.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,2108.85,85,,1687.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,1736.7,70,,1389.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,312,2108.85,
CLSD TRMT OF ULNAR SHAFT FRACTURE W/MANU,11025565,CDM,450,RC,25565,HCPCS,OUTPATIENT,,,1236.00,494.40,,,,,,other ,not seperately reimbursable,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,741.6,60,,593.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,675.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,865.2,70,,692.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,395.52,32,,316.42,percent of total billed charges,32% of total billed charges,395.52,1050.6,
ED CL TRMT DISTAL RAD FRAC WO MANIPULATI,11025600,CDM,450,RC,25600,HCPCS,OUTPATIENT,,,636.00,254.40,,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381.6,60,,305.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,433.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,540.6,85,,432.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,445.2,70,,356.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,32,,162.82,percent of total billed charges,32% of total billed charges,203.52,540.6,
CLSD TRMT DISTAL RADIAL FRACT W/MANIPLAT,11025605,CDM,450,RC,25605,HCPCS,OUTPATIENT,,,2481.00,992.40,,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1488.6,60,,1190.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,702.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,2108.85,85,,1687.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,1736.7,70,,1389.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,479,2108.85,
ED REDUCTION OF RAD DISLOCATION,11025675,CDM,450,RC,25675,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,422.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,422.5,
ED I & D FINGER ABCESS SIMPLE,11026010,CDM,450,RC,26010,HCPCS,OUTPATIENT,,,308.00,123.20,,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,60,,147.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,385,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,215.6,70,,172.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,32,,78.85,percent of total billed charges,32% of total billed charges,98.56,385,
ED I & D FINGER ABCESS COMPLICATED,11026011,CDM,450,RC,26011,HCPCS,OUTPATIENT,,,2256.00,902.40,,,,,,other ,not seperately reimbursable,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1353.6,60,,1082.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,612.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,1917.6,85,,1534.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,1579.2,70,,1263.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,721.92,32,,577.54,percent of total billed charges,32% of total billed charges,312,1917.6,
ED REPAIR EXTESOR TENDON FINGER,11026418,CDM,450,RC,26418,HCPCS,OUTPATIENT,,,2810.00,1124.00,,,,,,other ,not seperately reimbursable,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1686,60,,1348.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,800.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,2388.5,85,,1910.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,1967,70,,1573.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,899.2,32,,719.36,percent of total billed charges,32% of total billed charges,591,2388.5,
ED DISLOCAT/FRACTURE W/MANI EA BONE,11026605,CDM,450,RC,26605,HCPCS,OUTPATIENT,,,736.00,294.40,,,,,,other ,not seperately reimbursable,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,441.6,60,,353.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,426.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,515.2,70,,412.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,235.52,32,,188.42,percent of total billed charges,32% of total billed charges,235.52,625.6,
ED CLSD TREAT OF CARPOMETACARPAL DISLO,11026641,CDM,450,RC,26700,HCPCS,OUTPATIENT,,,908.00,363.20,,,,,,other ,not seperately reimbursable,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,544.8,60,,435.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,440.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,771.8,85,,617.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,635.6,70,,508.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,290.56,32,,232.45,percent of total billed charges,32% of total billed charges,290.56,771.8,
ED DISLOCAT CL FINGER METACARPOPH,11026700,CDM,450,RC,26705,HCPCS,OUTPATIENT,,,2481.00,992.40,,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1488.6,60,,1190.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,546.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,2108.85,85,,1687.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,1736.7,70,,1389.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,419,2108.85,
ED CL FRAC WO MAN CL PHALA SHAFT,11026720,CDM,450,RC,26720,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,256.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,287.3,
ED FRAC/DISLOCATION W/MANI W/WO TRACTIO,11026725,CDM,450,RC,26725,HCPCS,OUTPATIENT,,,787.00,314.80,,,,,,other ,not seperately reimbursable,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.2,60,,377.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,441.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,668.95,85,,535.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,550.9,70,,440.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,251.84,32,,201.47,percent of total billed charges,32% of total billed charges,251.84,668.95,
ED CL FRAC WO MAN CL DISTAL PHAL,11026750,CDM,450,RC,26750,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,287.3,
ED CL FRAC W MAN CL DISTAL PHAL,11026755,CDM,450,RC,26755,HCPCS,OUTPATIENT,,,675.00,270.00,,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405,60,,324,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,413.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,472.5,70,,378,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,573.75,
ED CL FRAC WO MAN OP TX PHAL FIX,11026765,CDM,450,RC,26765,HCPCS,OUTPATIENT,,,2427.00,970.80,,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1456.2,60,,1164.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,647.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,2062.95,85,,1650.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,776.64,32,,621.31,percent of total billed charges,32% of total billed charges,591,2062.95,
ED DISLOCAT CL FING IP JOINT W MA,11026770,CDM,450,RC,26770,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,370.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,370.71,
ED CLSD TRT OF KNUCKLE SINGLE W/MAN & AN,11026775,CDM,450,RC,26775,HCPCS,OUTPATIENT,,,1630.00,652.00,,,,,,other ,not seperately reimbursable,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,978,60,,782.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,506.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,1385.5,85,,1108.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,1141,70,,912.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,521.6,32,,417.28,percent of total billed charges,32% of total billed charges,506.06,1385.5,
ED CLD TREAT OF HIP DISLOC TRAMU WO/ANES,11027250,CDM,450,RC,27250,HCPCS,OUTPATIENT,,,590.00,236.00,,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,354,60,,283.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,413,70,,330.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,32,,151.04,percent of total billed charges,32% of total billed charges,188.8,501.5,
ER FRACTURE AND/OR DISLOCAT REQUIR ANES,11027252,CDM,450,RC,27252,HCPCS,OUTPATIENT,,,1981.00,792.40,,,,,,other ,not seperately reimbursable,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1188.6,60,,950.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,990.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,1683.85,85,,1347.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,633.92,32,,507.14,percent of total billed charges,32% of total billed charges,419,1683.85,
ED FRAC W MANIPULATION,11027268,CDM,450,RC,27268,HCPCS,OUTPATIENT,,,1339.00,535.60,,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.4,60,,642.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,710.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,1138.15,85,,910.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,937.3,70,,749.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,1138.15,
ED CLSD TREAT KNEE WO/ANES,11027550,CDM,450,RC,27550,HCPCS,OUTPATIENT,,,2232.00,892.80,,,,,,other ,not seperately reimbursable,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1339.2,60,,1071.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,670.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,1897.2,85,,1517.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,1562.4,70,,1249.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,714.24,32,,571.39,percent of total billed charges,32% of total billed charges,312,1897.2,
ED DISLOCAT CL PATELLA,11027560,CDM,450,RC,27560,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,422.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,422.5,
ED DISLOCAT/FRACTURE w/manipulation w/wo,11027752,CDM,450,RC,27752,HCPCS,OUTPATIENT,,,1600.00,640.00,,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,960,60,,768,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,696.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,1360,85,,1088,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,1120,70,,896,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,512,32,,409.6,percent of total billed charges,32% of total billed charges,512,32,,409.6,percent of total billed charges,32% of total billed charges,312,1360,
ED CLSD TRT OF DISTAL FIB W/MANIPULATION,11027788,CDM,450,RC,27788,HCPCS,OUTPATIENT,,,1200.00,480.00,,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,550.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,312,1020,
ED CLSD TX BIMALLEOLAR FX W MANI,11027810,CDM,450,RC,27810,HCPCS,OUTPATIENT,,,2481.00,992.40,,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1488.6,60,,1190.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,612.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,2108.85,85,,1687.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,1736.7,70,,1389.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,793.92,32,,635.14,percent of total billed charges,32% of total billed charges,312,2108.85,
ED TRMT ANKLE FRACT W/MANIPULATION,11027818,CDM,450,RC,27818,HCPCS,OUTPATIENT,,,1347.00,538.80,,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,808.2,60,,646.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,635.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,942.9,70,,754.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,312,1144.95,
ED CLOSED REDUCTION OF ANKLE DISL,11027840,CDM,450,RC,27840,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,422.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,422.5,
ED REMOVAL OF FB FOOT SUBCUTANEOUS,11028190,CDM,450,RC,28490,HCPCS,OUTPATIENT,,,1354.00,541.60,,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,812.4,60,,649.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,1150.9,85,,920.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,947.8,70,,758.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,433.28,32,,346.62,percent of total billed charges,32% of total billed charges,177.33,1150.9,
ED CL FRAC WO MAN CL FRAC GR TOE,11028490,CDM,450,RC,28490,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,287.3,
ED CL FRAC  MAN CL FRAC GR TOE W/ MANI,11028495,CDM,450,RC,28495,HCPCS,OUTPATIENT,,,454.00,181.60,,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.4,60,,217.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,224.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,317.8,70,,254.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,32,,116.22,percent of total billed charges,32% of total billed charges,145.28,385.9,
ED CL FRAC WO MAN CL OTHR GR TOE,11028510,CDM,450,RC,28510,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,150.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,287.3,
ED CL TRMT W/O MAN GREAT TOE PHALNGE,11028515,CDM,450,RC,28490,HCPCS,OUTPATIENT,,,425.00,170.00,,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,255,60,,204,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,297.5,70,,238,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,361.25,
ED CLSD TREAT TOE WO/ANES,11028630,CDM,450,RC,28630,HCPCS,OUTPATIENT,,,539.00,215.60,,,,,,other ,not seperately reimbursable,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.4,60,,258.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,194.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,458.15,85,,366.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,377.3,70,,301.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,172.48,32,,137.98,percent of total billed charges,32% of total billed charges,172.48,458.15,
ED DISLOCAT CL TOE IP JOINT,11028660,CDM,450,RC,28660,HCPCS,OUTPATIENT,,,338.00,135.20,,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.8,60,,162.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,236.6,70,,189.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,32,,86.53,percent of total billed charges,32% of total billed charges,108.16,287.3,
ED CAST PLACEMENT LONG ARM,11029065,CDM,450,RC,29065,HCPCS,OUTPATIENT,,,279.00,111.60,,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.4,60,,133.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,195.3,70,,156.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,237.15,
ED CAST PLACEMENT SHORT ARM,11029075,CDM,450,RC,29075,HCPCS,OUTPATIENT,,,255.00,102.00,,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153,60,,122.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,108.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,178.5,70,,142.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,216.75,
ED CASTING-PLASTER,11029085,CDM,450,RC,29085,HCPCS,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
ED SPLINT  PLACEMENT LONG ARM,11029105,CDM,450,RC,29105,HCPCS,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,102.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
ED SPLINT  PLACEMENT SHORT ARM SPLINT,11029125,CDM,450,RC,29125,HCPCS,OUTPATIENT,,,176.00,70.40,,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,60,,84.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,123.2,70,,98.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,149.6,
ED APPLICATION OF FINGER SPLINT;STATIC,11029130,CDM,450,RC,29130,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,52.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
ED strapping any age shoulder,11029240,CDM,450,RC,29240,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,37.6,113.9,
ED CAST PLACEMENT SHORT LEG,11029405,CDM,450,RC,29405,HCPCS,OUTPATIENT,,,265.00,106.00,,,,,,other ,not seperately reimbursable,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159,60,,127.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,99.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,225.25,85,,180.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,185.5,70,,148.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,84.8,32,,67.84,percent of total billed charges,32% of total billed charges,84.8,225.25,
"ED LONG LEG SPLINT APPLICATION THIGH,TOE",11029505,CDM,450,RC,29505,HCPCS,OUTPATIENT,,,260.00,104.00,,,,,,other ,not seperately reimbursable,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156,60,,124.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,182,70,,145.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,83.2,32,,66.56,percent of total billed charges,32% of total billed charges,83.2,221,
ER  APPLICATION SHORT LEG SPLINT(CALF/FO,11029515,CDM,450,RC,29515,HCPCS,OUTPATIENT,,,133.00,53.20,,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.8,60,,63.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,88.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,113.05,
ED SPLINT STRAPPING-TOES,11029550,CDM,450,RC,29550,HCPCS,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,23.83,75.65,
ED CAST REMOVAL,11029705,CDM,450,RC,29705,HCPCS,OUTPATIENT,,,523.00,209.20,,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.8,60,,251.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,366.1,70,,292.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,167.36,32,,133.89,percent of total billed charges,32% of total billed charges,79.5,444.55,
ED SIMPLE EXCISON NASAL POLYP,11030110,CDM,450,RC,30110,HCPCS,OUTPATIENT,,,2897.00,1158.80,,,,,,other ,not seperately reimbursable,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1738.2,60,,1390.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,2462.45,85,,1969.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,2027.9,70,,1622.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,927.04,32,,741.63,percent of total billed charges,32% of total billed charges,313.81,2462.45,
ER EXC B9LESION SNHFG 0.5 CM OR<,11030213,CDM,450,RC,11420,HCPCS,OUTPATIENT,,,1286.00,514.40,,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,159.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,159.61,1093.1,
ED FB REMO INTRANASAL,11030300,CDM,450,RC,30300,HCPCS,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,145,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,145,
ED ENT CONTR NASAL HEM SIMPLE ANT,11030901,CDM,450,RC,30901,HCPCS,OUTPATIENT,,,251.00,100.40,,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.6,60,,120.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,200.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,175.7,70,,140.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,213.35,
ED ENT CONTR NASAL HEM COMPLEX,11030903,CDM,450,RC,30903,HCPCS,OUTPATIENT,,,396.00,158.40,,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,237.6,60,,190.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,277.2,70,,221.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,336.6,
ED POST NASAL PACKING,11030905,CDM,450,RC,30905,HCPCS,OUTPATIENT,,,251.00,100.40,,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,150.6,60,,120.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,175.7,70,,140.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,32,,64.26,percent of total billed charges,32% of total billed charges,80.32,313.75,
CONTROL NASAL HEMORRHAGE,11030906,CDM,450,RC,30906,HCPCS,OUTPATIENT,,,283.00,113.20,,,,,,other ,not seperately reimbursable,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,169.8,60,,135.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,353.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,198.1,70,,158.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,90.56,32,,72.45,percent of total billed charges,32% of total billed charges,90.56,353.75,
ED NASAL ENDOSCOPY,11031231,CDM,450,RC,31231,HCPCS,OUTPATIENT,,,249.00,99.60,,,,,,other ,not seperately reimbursable,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.4,60,,119.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,235.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,211.65,85,,169.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,174.3,70,,139.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,79.68,32,,63.74,percent of total billed charges,32% of total billed charges,79.68,235.8,
ED ENT INTUBATION ENDOTRAC EMERG,11031500,CDM,450,RC,31500,HCPCS,OUTPATIENT,,,489.00,195.60,,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.4,60,,234.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,185.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,415.65,
ED CHANGE TRACH TUBE,11031502,CDM,450,RC,31502,HCPCS,OUTPATIENT,,,416.00,166.40,,,,,,other ,not seperately reimbursable,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.6,60,,199.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,45.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,353.6,85,,282.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,291.2,70,,232.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,133.12,32,,106.5,percent of total billed charges,32% of total billed charges,45.48,353.6,
ED LARYNOSCOPY,11031505,CDM,450,RC,31505,HCPCS,OUTPATIENT,,,264.00,105.60,,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,60,,126.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,184.8,70,,147.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,224.4,
ED ENDOSCOPY DIAGNOSTIC,11031525,CDM,450,RC,31505,HCPCS,OUTPATIENT,,,502.00,200.80,,,,,,other ,not seperately reimbursable,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.2,60,,240.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,426.7,85,,341.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,351.4,70,,281.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,160.64,32,,128.51,percent of total billed charges,32% of total billed charges,114.43,426.7,
"ED LARYNOSCOPY direct,operative, FB remo",11031530,CDM,450,RC,31530,HCPCS,OUTPATIENT,,,2347.00,938.80,,,,,,other ,not seperately reimbursable,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1408.2,60,,1126.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,257.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,1994.95,85,,1595.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,1642.9,70,,1314.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,751.04,32,,600.83,percent of total billed charges,32% of total billed charges,257.08,1994.95,
ED EMERGENCY TRACH,11031603,CDM,450,RC,31603,HCPCS,OUTPATIENT,,,1182.00,472.80,,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,709.2,60,,567.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,423.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,1004.7,85,,803.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,827.4,70,,661.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,312,1004.7,
ED TRACHEA CRICOTHYROID MEMBRANE,11031605,CDM,450,RC,31605,HCPCS,OUTPATIENT,,,1560.00,624.00,,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,936,60,,748.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,443.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,1326,85,,1060.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,1092,70,,873.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,443.79,1326,
ED TUBE THORACOSTOMY,11032020,CDM,450,RC,32551,HCPCS,OUTPATIENT,,,602.00,240.80,,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,361.2,60,,288.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,207.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,511.7,85,,409.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,421.4,70,,337.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,511.7,
ED THORACOTOMY,11032110,CDM,450,RC,32110,HCPCS,OUTPATIENT,,,4452.00,1780.80,,,,,,other ,not seperately reimbursable,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2671.2,60,,2136.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1956.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,3784.2,85,,3027.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,3116.4,70,,2493.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,1424.64,32,,1139.71,percent of total billed charges,32% of total billed charges,1424.64,3784.2,
ED TUBE THORACOSTOMY,11032551,CDM,450,RC,32551,HCPCS,OUTPATIENT,,,532.00,212.80,,,,,,other ,not seperately reimbursable,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,319.2,60,,255.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,207.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,452.2,85,,361.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,372.4,70,,297.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,170.24,32,,136.19,percent of total billed charges,32% of total billed charges,170.24,452.2,
"THORACENTESIS NDLE, W/O IMAGING",11032554,CDM,450,RC,32554,HCPCS,OUTPATIENT,,,1372.00,548.80,,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,823.2,60,,658.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,301.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,1166.2,85,,932.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,960.4,70,,768.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,439.04,32,,351.23,percent of total billed charges,32% of total billed charges,301.95,1166.2,
ED PERICARDIOCENTESIS,11033010,CDM,450,RC,33016,HCPCS,OUTPATIENT,,,602.00,240.80,,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361.2,60,,288.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,511.7,85,,409.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,421.4,70,,337.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,511.7,
ED PACEMAKER IMPLANT; TEMPORARY,11033210,CDM,361,RC,33210,HCPCS,OUTPATIENT,,,9988.00,3995.20,,3000,100,,,case rate,pays based on per visit rate,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5992.8,60,,4794.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,215.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,8489.8,85,,6791.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,6991.6,70,,5593.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,3196.16,32,,2556.93,percent of total billed charges,32% of total billed charges,215.13,8489.8,
REP BLOOD VESSEL LOWER EXTREMITY,11035226,CDM,450,RC,35226,HCPCS,OUTPATIENT,,,1286.00,514.40,,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1113.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,1113.94,
ED VASC NON ROUTINE VEINPUNCTURE,11036410,CDM,450,RC,36410,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
ED BLOOD TRANSFUSION,11036430,CDM,391,RC,36430,HCPCS,OUTPATIENT,,,842.00,336.80,,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,505.2,60,,404.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,46.33,715.7,
ED VASC CVP LINE INSERTION > 5 Y/O,11036489,CDM,450,RC,36556,HCPCS,OUTPATIENT,,,2207.00,882.80,,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1324.2,60,,1059.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,273.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,1875.95,85,,1500.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,1544.9,70,,1235.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,273.35,1875.95,
CATHERIZATION OF UMBILICAL VEIN/NEWBORN,11036510,CDM,450,RC,36510,HCPCS,OUTPATIENT,,,162.00,64.80,,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.2,60,,77.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,113.4,70,,90.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,137.7,
INSERTION CENTRAL VENOUS ACCESS DEVICE,11036556,CDM,450,RC,36556,HCPCS,OUTPATIENT,,,2207.00,882.80,,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1324.2,60,,1059.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,273.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,1875.95,85,,1500.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,1544.9,70,,1235.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,706.24,32,,564.99,percent of total billed charges,32% of total billed charges,273.35,1875.95,
PERI INSERTED CV CATH W/PORT>.5YRS OLD,11036558,CDM,450,RC,36558,HCPCS,OUTPATIENT,,,3382.00,1352.80,,,,,,other ,not seperately reimbursable,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2029.2,60,,1623.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1073.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,2874.7,85,,2299.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,2367.4,70,,1893.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,1082.24,32,,865.79,percent of total billed charges,32% of total billed charges,419,2874.7,
PICC LINE ER INSERT W/O IMAGING,11036569,CDM,450,RC,36569,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,121.45,2895.95,
ED INSERTION OF CENTRAL VENOUS CATHIER,11036570,CDM,450,RC,36556,HCPCS,OUTPATIENT,,,3620.00,1448.00,,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2172,60,,1737.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,273.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,3077,85,,2461.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,2534,70,,2027.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,273.35,3077,
PICC LINE ER INSERT W/ IMAGING,11036573,CDM,450,RC,36573,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,490.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,490.51,2895.95,
"REP CVA ER CATH W/O P/P, W/C/P INS SITE",11036575,CDM,450,RC,36575,HCPCS,OUTPATIENT,,,1312.00,524.80,,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,787.2,60,,629.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,188.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,1115.2,85,,892.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,918.4,70,,734.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,419.84,32,,335.87,percent of total billed charges,32% of total billed charges,188.3,1115.2,
PICC REPL ER COMP W/O IMG SME VEIN ACCES,11036580,CDM,450,RC,36580,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,243.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,243.5,2895.95,
PICC REPL ER COMP  W/IMG SV ACCES,11036584,CDM,450,RC,36584,HCPCS,OUTPATIENT,,,3407.00,1362.80,,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2044.2,60,,1635.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2895.95,85,,2316.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,2384.9,70,,1907.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,1090.24,32,,872.19,percent of total billed charges,32% of total billed charges,312,2895.95,
BLOOD COLLECTION FRM IMPLTED VAD,11036591,CDM,761,RC,36591,HCPCS,OUTPATIENT,,,242.00,96.80,,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.2,60,,116.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,169.4,70,,135.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,32.3,205.7,
BLD COLLECT FRM EST VENOUS CATH/LINE,11036592,CDM,761,RC,36592,HCPCS,OUTPATIENT,,,242.00,96.80,,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.2,60,,116.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,169.4,70,,135.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,35.95,205.7,
PLACE  NEEDLE FOR INTRAOSSEOUS INFUSION,11036680,CDM,450,RC,36680,HCPCS,OUTPATIENT,,,655.00,262.00,,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393,60,,314.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,78.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,458.5,70,,366.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,78.56,556.75,
ED SUTURE OF ARTERY,11037618,CDM,450,RC,37618,HCPCS,OUTPATIENT,,,1146.00,458.40,,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,687.6,60,,550.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,514.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,974.1,85,,779.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,802.2,70,,641.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,974.1,
ED BIOPSY OR EXCISION OF LYMPH NODE(S),11038500,CDM,450,RC,38500,HCPCS,OUTPATIENT,,,6124.00,2449.60,,,,,,other ,not seperately reimbursable,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3674.4,60,,2939.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,440.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,5205.4,85,,4164.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,4286.8,70,,3429.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,1959.68,32,,1567.74,percent of total billed charges,32% of total billed charges,419,5205.4,
"ED repair of lac 2.5 or less,mouth or t",11041250,CDM,450,RC,41250,HCPCS,OUTPATIENT,,,730.00,292.00,,,,,,other ,not seperately reimbursable,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,438,60,,350.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,359.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,620.5,85,,496.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,511,70,,408.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,233.6,32,,186.88,percent of total billed charges,32% of total billed charges,233.6,620.5,
"ED REPAIR LAC OF TONGUE,MOUTH>2.6",11041252,CDM,450,RC,41252,HCPCS,OUTPATIENT,,,1560.00,624.00,,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,936,60,,748.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,419.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,1326,85,,1060.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,1092,70,,873.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,499.2,32,,399.36,percent of total billed charges,32% of total billed charges,419,1326,
"DRAINAGE OF ABSCESS,CYSTFROM DENTOALV",11041800,CDM,450,RC,41800,HCPCS,OUTPATIENT,,,334.00,133.60,,,,,,other ,not seperately reimbursable,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,200.4,60,,160.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,363.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,233.8,70,,187.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,106.88,32,,85.5,percent of total billed charges,32% of total billed charges,106.88,363.86,
ED REMOVAL EB FRM DENTOAIVEOLAR S,11041805,CDM,450,RC,41805,HCPCS,OUTPATIENT,,,4229.00,1691.60,,,,,,other ,not seperately reimbursable,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2537.4,60,,2029.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,389.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,3594.65,85,,2875.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,2960.3,70,,2368.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,1353.28,32,,1082.62,percent of total billed charges,32% of total billed charges,312,3594.65,
ED REMOVAL FB PHARNYX,11042809,CDM,450,RC,42809,HCPCS,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,145,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,145,
ED ESOPHAGOSCOPY,11043200,CDM,450,RC,43200,HCPCS,OUTPATIENT,,,1463.00,585.20,,,,,,other ,not seperately reimbursable,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,877.8,60,,702.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,335.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,1243.55,85,,994.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,1024.1,70,,819.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,468.16,32,,374.53,percent of total billed charges,32% of total billed charges,312,1243.55,
"ED ENDOSCOPY W/BIOPSY, SINGLE OR MULT",11043239,CDM,450,RC,43239,HCPCS,OUTPATIENT,,,874.00,349.60,,,,,,other ,not seperately reimbursable,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,524.4,60,,419.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,484.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,742.9,85,,594.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,611.8,70,,489.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,279.68,32,,223.74,percent of total billed charges,32% of total billed charges,279.68,742.9,
ED ENDOSCOPY W/REMOVAL FOREIGN BODY,11043247,CDM,450,RC,43247,HCPCS,OUTPATIENT,,,1669.00,667.60,,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1001.4,60,,801.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,493.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1418.65,85,,1134.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,1168.3,70,,934.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,534.08,32,,427.26,percent of total billed charges,32% of total billed charges,419,1418.65,
ED CHANGE/REPLACE OF GASTROSTOMY TUBE,11043760,CDM,450,RC,43762,HCPCS,OUTPATIENT,,,515.00,206.00,,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,309,60,,247.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,289.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,437.75,85,,350.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,360.5,70,,288.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,437.75,
ED ABCESS PERIRECTAL,11046040,CDM,450,RC,46040,HCPCS,OUTPATIENT,,,3217.00,1286.80,,,,,,other ,not seperately reimbursable,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1930.2,60,,1544.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,721.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,2734.45,85,,2187.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,2251.9,70,,1801.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,1029.44,32,,823.55,percent of total billed charges,32% of total billed charges,479,2734.45,
ED I & D ABCESS PERIANAL,11046050,CDM,450,RC,46050,HCPCS,OUTPATIENT,,,783.00,313.20,,,,,,other ,not seperately reimbursable,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,469.8,60,,375.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,300.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,665.55,85,,532.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,548.1,70,,438.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,250.56,32,,200.45,percent of total billed charges,32% of total billed charges,250.56,665.55,
ED INCIS OF THROMBOSED EX HEMORRH,11046083,CDM,450,RC,46083,HCPCS,OUTPATIENT,,,515.00,206.00,,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,309,60,,247.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,267.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,437.75,85,,350.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,360.5,70,,288.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,32,,131.84,percent of total billed charges,32% of total billed charges,164.8,437.75,
EXC THROMBOSED HEMORRHOID,11046320,CDM,450,RC,46320,HCPCS,OUTPATIENT,,,2512.00,1004.80,,,,,,other ,not seperately reimbursable,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1507.2,60,,1205.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,272.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,2135.2,85,,1708.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,1758.4,70,,1406.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,803.84,32,,643.07,percent of total billed charges,32% of total billed charges,272.73,2135.2,
ED ANOSCOPY,11046600,CDM,450,RC,46600,HCPCS,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,145,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,145,
ED PARACENTESIS,11049080,CDM,450,RC,49082,HCPCS,OUTPATIENT,,,853.00,341.20,,,,,,other ,not seperately reimbursable,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,511.8,60,,409.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,270.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,725.05,85,,580.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,597.1,70,,477.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,272.96,32,,218.37,percent of total billed charges,32% of total billed charges,270.55,725.05,
"ED BLADDER IRRIGATION, SIMPLE",11051700,CDM,450,RC,51700,HCPCS,OUTPATIENT,,,230.00,92.00,,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138,60,,110.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,161,70,,128.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,195.5,
ED BLADDER INSERT OF NON-DWELL CATH,11051701,CDM,450,RC,51701,HCPCS,OUTPATIENT,,,141.00,56.40,,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,57.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,119.85,
INSERT TEMP BLADDER CATH SIMPLE,11051702,CDM,450,RC,51702,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,200.6,
INSERT TEMP BLADDER CMPLX,11051703,CDM,450,RC,51703,HCPCS,OUTPATIENT,,,268.00,107.20,,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,60,,128.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,190.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,227.8,
ED CHANGE OF CYSTOSTOMY TUBE SIMPLE,11051705,CDM,450,RC,51705,HCPCS,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
ED URETHRAL DILATION,11053600,CDM,450,RC,53600,HCPCS,OUTPATIENT,,,371.00,148.40,,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.6,60,,178.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,259.7,70,,207.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,118.72,32,,94.98,percent of total billed charges,32% of total billed charges,112.2,315.35,
ED URETHRAL DILATION of filiform & follo,11053620,CDM,450,RC,53620,HCPCS,OUTPATIENT,,,1187.00,474.80,,,,,,other ,not seperately reimbursable,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,712.2,60,,569.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,218.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,1008.95,85,,807.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,830.9,70,,664.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,379.84,32,,303.87,percent of total billed charges,32% of total billed charges,218.15,1008.95,
ED SUTURE O REPAIR OF TESTICULAR INJURY,11054370,CDM,450,RC,13131,HCPCS,OUTPATIENT,,,1196.00,478.40,,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,717.6,60,,574.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,489.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,1016.6,85,,813.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,837.2,70,,669.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,1016.6,
ED FORESKIN MANIPULATION,11054450,CDM,450,RC,54450,HCPCS,OUTPATIENT,,,467.00,186.80,,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,280.2,60,,224.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,326.9,70,,261.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,86.35,396.95,
ED SUTURE OR REPAIR TESTICULAR INJURY,11054670,CDM,450,RC,54670,HCPCS,OUTPATIENT,,,1196.00,478.40,,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,717.6,60,,574.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,521.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,1016.6,85,,813.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,837.2,70,,669.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,32,,306.18,percent of total billed charges,32% of total billed charges,382.72,1016.6,
ED I&D OF VULVAR ABCESS,11056405,CDM,450,RC,56405,HCPCS,OUTPATIENT,,,694.00,277.60,,,,,,other ,not seperately reimbursable,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,416.4,60,,333.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,190.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,589.9,85,,471.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,485.8,70,,388.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,222.08,32,,177.66,percent of total billed charges,32% of total billed charges,190.86,589.9,
ED I&D BARTHOLIN CYST,11056420,CDM,450,RC,56420,HCPCS,OUTPATIENT,,,390.00,156.00,,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,238.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,331.5,
ED REMOVAL FOREIGN BODY FROM VAGINA,11057415,CDM,450,RC,57415,HCPCS,OUTPATIENT,,,3463.00,1385.20,,,,,,other ,not seperately reimbursable,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2077.8,60,,1662.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,2943.55,85,,2354.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,2424.1,70,,1939.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,1108.16,32,,886.53,percent of total billed charges,32% of total billed charges,227.78,2943.55,
ED ENDOMETRIAL BIOPSY,11058100,CDM,450,RC,58100,HCPCS,OUTPATIENT,,,296.00,118.40,,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,60,,142.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,132.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,251.6,
ED FETAL MONITORING BY PHYS,11059050,CDM,731,RC,59050,HCPCS,OUTPATIENT,,,242.00,96.80,,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.2,60,,116.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,169.4,70,,135.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,67.83,205.7,
ED REPAIR PF PERINEAL LACERATION,11059300,CDM,450,RC,59300,HCPCS,OUTPATIENT,,,2410.00,964.00,,,,,,other ,not seperately reimbursable,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1446,60,,1156.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,303.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,2048.5,85,,1638.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,1687,70,,1349.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,771.2,32,,616.96,percent of total billed charges,32% of total billed charges,303.65,2048.5,
VAGINAL DELIVERY ONLY W/O EPI/FOR,11059409,CDM,450,RC,59409,HCPCS,OUTPATIENT,,,5544.00,2217.60,,,,,,other ,not seperately reimbursable,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3326.4,60,,2661.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1081.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,4712.4,85,,3769.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,3880.8,70,,3104.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,1774.08,32,,1419.26,percent of total billed charges,32% of total billed charges,1081.84,4712.4,
ED EMERG VAGINAL DELIVERY,11059410,CDM,450,RC,59410,HCPCS,OUTPATIENT,,,3198.00,1279.20,,,,,,other ,not seperately reimbursable,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1918.8,60,,1535.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1424.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,2718.3,85,,2174.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,2238.6,70,,1790.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,1023.36,32,,818.69,percent of total billed charges,32% of total billed charges,1023.36,2718.3,
ED DELIVERY OF PLACENTA,11059414,CDM,450,RC,59414,HCPCS,OUTPATIENT,,,6492.00,2596.80,,,,,,other ,not seperately reimbursable,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3895.2,60,,3116.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,5518.2,85,,4414.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,4544.4,70,,3635.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,2077.44,32,,1661.95,percent of total billed charges,32% of total billed charges,121.73,5518.2,
ER POSTPARTUM CARE INCLUDED,11059614,CDM,450,RC,59614,HCPCS,OUTPATIENT,,,2998.00,1199.20,,,,,,other ,not seperately reimbursable,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1798.8,60,,1439.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1553.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,2548.3,85,,2038.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,2098.6,70,,1678.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,959.36,32,,767.49,percent of total billed charges,32% of total billed charges,959.36,2548.3,
ED LUMBAR PUNCTURE,11062270,CDM,450,RC,62270,HCPCS,OUTPATIENT,,,1324.00,529.60,,,,,,other ,not seperately reimbursable,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,794.4,60,,635.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,160.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,1125.4,85,,900.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,926.8,70,,741.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,423.68,32,,338.94,percent of total billed charges,32% of total billed charges,160.64,1125.4,
INJ ANESTH AGNT TRIGEMINAL NRVE,11064400,CDM,450,RC,64400,HCPCS,OUTPATIENT,,,506.00,202.40,,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303.6,60,,242.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,354.2,70,,283.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,143.96,430.1,
INJ ANESTHETIC AGT FACIAL NRV,11064402,CDM,450,RC,64999,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,200.6,
INJ ANESTH AGT/STEROID GRTR OPTICAL NERV,11064405,CDM,450,RC,64405,HCPCS,OUTPATIENT,,,633.00,253.20,,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.8,60,,303.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,97.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,538.05,85,,430.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,443.1,70,,354.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,202.56,32,,162.05,percent of total billed charges,32% of total billed charges,97.96,538.05,
ED PERIPHERAL NERVE BRANCH BLK,11064450,CDM,450,RC,64450,HCPCS,OUTPATIENT,,,396.00,158.40,,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.6,60,,190.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,95.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,277.2,70,,221.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,126.72,32,,101.38,percent of total billed charges,32% of total billed charges,95.7,336.6,
ED FB REMO EYE CONJUNCTIVA SUPERF,11065205,CDM,450,RC,65205,HCPCS,OUTPATIENT,,,267.00,106.80,,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.2,60,,128.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,36.68,226.95,
ED FB REMO EYE CONJUNCTIVA EMBEDD,11065210,CDM,450,RC,65210,HCPCS,OUTPATIENT,,,267.00,106.80,,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.2,60,,128.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,48.76,226.95,
ED FB REMO CORNEAL WO SLIT LAMP,11065220,CDM,450,RC,65220,HCPCS,OUTPATIENT,,,267.00,106.80,,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.2,60,,128.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,75.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,75.7,226.95,
ED FB REMO CORNEAL W SLIT LAMP,11065222,CDM,450,RC,65222,HCPCS,OUTPATIENT,,,267.00,106.80,,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.2,60,,128.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,83.71,226.95,
"ED BLEPHAROTOMY,DRAIN ABSCESS EYELID",11067700,CDM,450,RC,67700,HCPCS,OUTPATIENT,,,274.00,109.60,,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.4,60,,131.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,342.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,191.8,70,,153.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,32,,70.14,percent of total billed charges,32% of total billed charges,87.68,342.5,
ED REMOVAL OF EMBEDDED FOREIGN BODY EYE,11067938,CDM,450,RC,67938,HCPCS,OUTPATIENT,,,271.00,108.40,,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.6,60,,130.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,338.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,189.7,70,,151.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,86.72,32,,69.38,percent of total billed charges,32% of total billed charges,86.72,338.64,
TENDON REP EXT FOOT EA TENDON,11068208,CDM,450,RC,28208,HCPCS,OUTPATIENT,,,5435.00,2174.00,,,,,,other ,not seperately reimbursable,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,3261,60,,2608.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,604.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,4619.75,85,,3695.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,3804.5,70,,3043.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,1739.2,32,,1391.36,percent of total billed charges,32% of total billed charges,479,4619.75,
ED CONJUNCTOPLASTY,11068320,CDM,450,RC,68320,HCPCS,OUTPATIENT,,,3274.00,1309.60,,,,,,other ,not seperately reimbursable,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,591,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1964.4,60,,1571.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,920.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,2782.9,85,,2226.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,2291.8,70,,1833.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,1047.68,32,,838.14,percent of total billed charges,32% of total billed charges,591,2782.9,
ED EX EAR DRAINAGE/ABCESS OR HEMATOMA,11069000,CDM,450,RC,69000,HCPCS,OUTPATIENT,,,585.00,234.00,,,,,,other ,not seperately reimbursable,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,351,60,,280.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,236.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,497.25,85,,397.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,409.5,70,,327.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,187.2,32,,149.76,percent of total billed charges,32% of total billed charges,187.2,497.25,
"ED I & D EX AUDITORY CANAL, ABCESS",11069020,CDM,450,RC,69020,HCPCS,OUTPATIENT,,,702.00,280.80,,,,,,other ,not seperately reimbursable,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421.2,60,,336.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,296.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,596.7,85,,477.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,491.4,70,,393.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,224.64,32,,179.71,percent of total billed charges,32% of total billed charges,224.64,596.7,
ED FB REMO EAR AUDITORY CANAL,11069200,CDM,450,RC,69200,HCPCS,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,101.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,101.06,
REM IMPACTED CERUMEN IRRG/LAV UNI,11069209,CDM,450,RC,69209,HCPCS,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,18.49,107.1,
ED FB REMO EAR IMPACTED CERUMEN,11069210,CDM,450,RC,69210,HCPCS,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,60.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,98.6,
FECAL BLOOD FOBT DX,11082272,CDM,301,RC,82272,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
ED GASTRIC INTUBATION,11089135,CDM,450,RC,43754,HCPCS,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,285.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,285.63,
ED RHO(D)IMMUNE GLOBULIN-full dose,11090384,CDM,450,RC,90384,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
ED RHO(D)IMMUNE GLOBULIN,11090385,CDM,450,RC,90385,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
ED INJ IM ADMIN THRO 18YRS W/PHYS,11090460,CDM,450,RC,90460,HCPCS,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,20.56,62.05,
ED INJ IM add'l THRO 18YRS W/PHYS,11090461,CDM,450,RC,90461,HCPCS,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,15.64,62.05,
ED INJ IM ADMIN 1 VACCINE(SINGLE OR COM,11090471,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,20.56,111.35,
ED EA ADDL INJ IM ADMIN 1 VACCINE(SINGL,11090472,CDM,771,RC,90472,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
RABIES VACCINE 1ML:1ML,11090675,CDM,636,RC,90675,HCPCS,OUTPATIENT,,,526.00,210.40,,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.6,60,,252.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,447.1,
RABIES VACCINE 1ML: 1ML,11090676,CDM,636,RC,90676,HCPCS,OUTPATIENT,,,526.00,210.40,,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.6,60,,252.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,368.2,70,,294.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,32,,134.66,percent of total billed charges,32% of total billed charges,168.32,447.1,
RABIES IMMUNE GLOBULIN,11090677,CDM,636,RC,90377,HCPCS,OUTPATIENT,,,597.00,238.80,,,,,,other ,not seperately reimbursable,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.2,60,,286.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,417.9,70,,334.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,191.04,32,,152.83,percent of total billed charges,32% of total billed charges,191.04,507.45,
"ED ADM TETANUS, DIPHTHERIA TOXIOD",11090718,CDM,771,RC,90471,HCPCS,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,20.56,111.35,
"ED INJ IM ADMIN HEP B, ADULT DOSE",11090746,CDM,450,RC,90746,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
IV INFUSION THERAPY-1ST HR,11090780,CDM,262,RC,96365,HCPCS,OUTPATIENT,,,408.00,163.20,,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,60,,195.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,285.6,70,,228.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,82.65,346.8,
IV INFUSION THERAPY EA  ADD'L HR,11090781,CDM,262,RC,96366,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,25.86,80.75,
"INJ, IM/SQ THERAPEUTIC",11090782,CDM,761,RC,96372,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,17.71,113.9,
ED INJ INTRA-ARTERIAL,11090783,CDM,450,RC,96373,HCPCS,OUTPATIENT,,,186.00,74.40,,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.6,60,,89.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,130.2,70,,104.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,22.19,158.1,
IV PUSH INITIAL,11090784,CDM,262,RC,96374,HCPCS,OUTPATIENT,,,506.00,202.40,,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303.6,60,,242.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,354.2,70,,283.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,161.92,32,,129.54,percent of total billed charges,32% of total billed charges,48.01,430.1,
"ED INJ, IM",11090788,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,159.00,63.60,,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.4,60,,76.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,111.3,70,,89.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,17.71,135.15,
ED NG TUBE LAVAGE ASPIRATION,11091105,CDM,450,RC,43753,HCPCS,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,29.51,257.55,
ED CPR,11092950,CDM,450,RC,92950,HCPCS,OUTPATIENT,,,641.00,256.40,,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.6,60,,307.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,544.85,85,,435.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,448.7,70,,358.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,32,,164.1,percent of total billed charges,32% of total billed charges,205.12,544.85,
ED TRANSCUTANEOUS PACING,11092953,CDM,450,RC,92953,HCPCS,OUTPATIENT,,,489.00,195.60,,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.4,60,,234.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,1.45,415.65,
ED ELECTIVE CARDIOVERSION,11092960,CDM,450,RC,92960,HCPCS,OUTPATIENT,,,1016.00,406.40,,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,609.6,60,,487.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,195.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,863.6,85,,690.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,711.2,70,,568.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,325.12,32,,260.1,percent of total billed charges,32% of total billed charges,195.13,863.6,
ED VASC THROMB BY IV INFUSION,11092977,CDM,450,RC,92977,HCPCS,OUTPATIENT,,,465.00,186.00,,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,279,60,,223.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,325.5,70,,260.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,64.5,395.25,
ED TELEMETRY,11093012,CDM,732,RC,,,OUTPATIENT,,,186.00,74.40,,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.6,60,,89.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,130.2,70,,104.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,158.1,
ED DIAG RYTHM STRIP INTERP W REPO,11093042,CDM,450,RC,93042,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.73,23.8,
ED EXT RYTHM STRIP SCANNIN INTERP W REPO,11093224,CDM,450,RC,93226,HCPCS,OUTPATIENT,,,292.00,116.80,,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,480.08,272,,,fee schedule,272% of BCBS fee schedule,480.08,272,,,fee schedule,272% of BCBS fee schedule,480.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,175.2,60,,140.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,45.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,204.4,70,,163.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,93.44,32,,74.75,percent of total billed charges,32% of total billed charges,45.7,480.08,
ED HOLTER MONITOR,11093225,CDM,731,RC,93225,HCPCS,OUTPATIENT,,,321.00,128.40,,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,272.14,272,,,fee schedule,272% of BCBS fee schedule,272.14,272,,,fee schedule,272% of BCBS fee schedule,272.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,192.6,60,,154.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,224.7,70,,179.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,23.36,272.85,
ED VENTILATOR ER,11094656,CDM,450,RC,94002,HCPCS,OUTPATIENT,,,441.00,176.40,,,,,,other ,not seperately reimbursable,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.6,60,,211.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,374.85,85,,299.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,308.7,70,,246.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,141.12,32,,112.9,percent of total billed charges,32% of total billed charges,118.56,374.85,
***CPAP SETUP,11094660,CDM,410,RC,94660,HCPCS,OUTPATIENT,,,348.00,139.20,,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.8,60,,167.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,295.8,85,,236.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,243.6,70,,194.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,79.86,295.8,
ED DIAG PULSE OXIMETRY,11094760,CDM,460,RC,94760,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,3.05,57.96,
ED DIAG PULSE OX MULTIPLE,11094761,CDM,460,RC,94761,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,151.1,272,,,fee schedule,272% of BCBS fee schedule,151.1,272,,,fee schedule,272% of BCBS fee schedule,151.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,4.28,151.1,
"ED INTRAVENOUS INFUSION,HYDRATION>31<60",11096360,CDM,450,RC,96360,HCPCS,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,41.9,157.25,
IV HYDRATION ADDNL 1HR,11096361,CDM,262,RC,96361,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,15.88,80.75,
ED EA ADD'L HOUR/INTRA VENOUS,11096366,CDM,450,RC,96366,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
"ED THERAP, PROHYL OR DIAG INJECTION",11096372,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,17.71,48.45,
"ED INTRAVENOUS PUSH, SINGLE/INITIAL SUB",11096374,CDM,450,RC,96374,HCPCS,OUTPATIENT,,,429.00,171.60,,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.4,60,,205.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,300.3,70,,240.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,48.01,364.65,
IV PUSH SEQUENT NEW DRUG,11096375,CDM,262,RC,96375,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,19.56,72.25,
IV PUSH SEQUENT SAME DRUG,11096376,CDM,262,RC,96376,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
"ED INJ,unlisted introv inj or infusion",11096379,CDM,450,RC,96379,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
PORT FLUSH,11096523,CDM,761,RC,96523,HCPCS,OUTPATIENT,,,122.00,48.80,,17.04,80,,,fee schedule,80% of Aetna fee schedule,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,17.04,103.7,
"ED DEBRIDEMENT, waterjet, AREA >20sq cm",11097597,CDM,450,RC,97598,HCPCS,OUTPATIENT,,,1096.00,438.40,,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,657.6,60,,526.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,57.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,931.6,85,,745.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,767.2,70,,613.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,350.72,32,,280.58,percent of total billed charges,32% of total billed charges,57.65,931.6,
ED REMOVABLE DEVIATLIZED TISSUE FROM WOU,11097602,CDM,450,RC,97602,HCPCS,OUTPATIENT,,,184.00,73.60,,,,,,other ,not seperately reimbursable,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,60,,88.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,128.8,70,,103.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,58.88,32,,47.1,percent of total billed charges,32% of total billed charges,58.88,156.4,
MOD SED SME PHYS <5 Y/O INITIAL 15 MIN,11099151,CDM,450,RC,99151,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,68.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,68.75,
MOD SED SME PHYS >5 Y/O INITIAL 15 MIN,11099152,CDM,450,RC,99152,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,62.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,62.85,
MOD SED SME OR OTH PHYS ADDNL 15 MIN,11099153,CDM,450,RC,99152,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,62.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,62.85,
ED IPECAC ADMINISTRATION,11099175,CDM,450,RC,99175,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,34.74,163.2,
ED OBVS LOW COMPLEXITY,11099218,CDM,762,RC,99282,HCPCS,OUTPATIENT,,,382.00,152.80,,750,100,,,case rate,pays based on per visit rate,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.2,60,,183.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,54.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,267.4,70,,213.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,54.96,750,
ED OBVS MED COMPLEXITY,11099219,CDM,762,RC,99283,HCPCS,OUTPATIENT,,,763.00,305.20,,750,100,,,case rate,pays based on per visit rate,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.8,60,,366.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,534.1,70,,427.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,244.16,32,,195.33,percent of total billed charges,32% of total billed charges,93.79,750,
ED OBVS HIGH COMPLEXITY,11099220,CDM,762,RC,99284,HCPCS,OUTPATIENT,,,1145.00,458.00,,750,100,,,case rate,pays based on per visit rate,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,687,60,,549.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,157.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,801.5,70,,641.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,366.4,32,,293.12,percent of total billed charges,32% of total billed charges,157.84,973.25,
ER LEVEL 1-MINIMAL,11099281,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,162.00,64.80,,750,100,,,case rate,pays based on per visit rate,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.2,60,,77.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,113.4,70,,90.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,28.33,750,
ER LEVEL 2-ROUTINE,11099282,CDM,450,RC,99282,HCPCS,OUTPATIENT,,,297.00,118.80,,750,100,,,case rate,pays based on per visit rate,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,54.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,54.96,750,
ER LEVEL 3-URGENT,11099283,CDM,450,RC,99283,HCPCS,OUTPATIENT,,,531.00,212.40,,750,100,,,case rate,pays based on per visit rate,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.6,60,,254.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,371.7,70,,297.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,93.79,750,
ER LEVEL 4-COMPLEX,11099284,CDM,450,RC,99284,HCPCS,OUTPATIENT,,,885.00,354.00,,750,100,,,case rate,pays based on per visit rate,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,531,60,,424.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,157.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,752.25,85,,601.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,619.5,70,,495.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,157.84,752.25,
ER LEVEL 5-CRITICAL,11099285,CDM,450,RC,99285,HCPCS,OUTPATIENT,,,1317.00,526.80,,750,100,,,case rate,pays based on per visit rate,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,790.2,60,,632.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,229.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,921.9,70,,737.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,229.56,1119.45,
CRITICAL CARE FIRST HR,11099291,CDM,450,RC,99291,HCPCS,OUTPATIENT,,,1806.00,722.40,,750,100,,,case rate,pays based on per visit rate,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1083.6,60,,866.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,352.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,1535.1,85,,1228.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,1264.2,70,,1011.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,352.11,1535.1,
CRITICAL CARE EA ADD'L 30MIN,11099292,CDM,450,RC,99292,HCPCS,OUTPATIENT,,,332.00,132.80,,750,100,,,case rate,pays based on per visit rate,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.2,60,,159.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,155.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,232.4,70,,185.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,750,
IV HYDRATION INIT 31MIN-1HR,11099760,CDM,262,RC,96360,HCPCS,OUTPATIENT,,,408.00,163.20,,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,60,,195.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,285.6,70,,228.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,41.9,346.8,
ED INFUSION IV THERAPY ADD'L HR,11099761,CDM,262,RC,96361,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,15.88,51.85,
IV INFUSION ADD'L SEQ THERAPY-1ST HR,11099767,CDM,262,RC,96367,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,37.08,113.9,
IV INFUSION CONCURRENT THERAPY,11099768,CDM,262,RC,96368,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
ED INJ EA ADD'L DRUG INTRA 2,11099775,CDM,260,RC,96375,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,19.56,70.55,
VACCINE ADMIN INFLUENZA,11099800,CDM,771,RC,G0008,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
VACCINE ADMIN PNEUMOCOCCAL,11099801,CDM,771,RC,G0009,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
ADM COVID VACCINE (PFIZER) 1ST DOSE,11099802,CDM,771,RC,0001A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (PFIZER) 2ND DOSE,11099803,CDM,771,RC,0002A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (MODERNA) 1ST DOSE,11099804,CDM,771,RC,0011A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (MODERNA) 2ND DOSE,11099805,CDM,771,RC,0012A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (ASTRA ZEN) 1ST DOSE,11099806,CDM,771,RC,0021A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (ASTRA ZEN) 2ND DOSE,11099807,CDM,771,RC,0022A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADM COVID VACCINE (JANSSEN-J&J) SINGLE D,11099808,CDM,771,RC,0031A,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
ED WND RP-SIMPLE-scal/arm/leg UP TO 2.5C,11112001,CDM,450,RC,12001,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-scal/arm/lgs 2.6-7.5CM,11112002,CDM,450,RC,12002,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-scal/ams/lgs 7.6-12.5CM,11112004,CDM,450,RC,12004,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,168.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,275.4,
ED WND RP-SIMPLE-scal/ams/lgs 12.6-20.0C,11112005,CDM,450,RC,12005,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-SIMPLE-scal/arm/lgs 20.1-30.0C,11112006,CDM,450,RC,12006,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,267,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-SIMPLE-scal/arm/lgs >30 cm,11112007,CDM,450,RC,12007,HCPCS,OUTPATIENT,,,839.00,335.60,,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,503.4,60,,402.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,301.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,713.15,85,,570.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,587.3,70,,469.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,32,,214.78,percent of total billed charges,32% of total billed charges,268.48,713.15,
ED WND PR-INTEMED-scal/arm/lgs EXT 2.5CM,11112031,CDM,450,RC,12031,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,331.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,331.53,
ED WND PR-INTERMED-scal/arm/lgs 2.6-7.5C,11112032,CDM,450,RC,12032,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,379.23,
ED WND RP-INTERMED-scal/arm/lgs 7.6-12.5,11112034,CDM,450,RC,12034,HCPCS,OUTPATIENT,,,324.00,129.60,,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,194.4,60,,155.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,405,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,226.8,70,,181.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,32,,82.94,percent of total billed charges,32% of total billed charges,103.68,419,
ED WND RP-INTERMED-scal/arm/lgs 12.6-20,11112035,CDM,450,RC,12035,HCPCS,OUTPATIENT,,,720.00,288.00,,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,432,60,,345.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,496.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,504,70,,403.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,612,
ED WND RP-INTERMED-scal/arm/lg 20.1-30ML,11112036,CDM,450,RC,12036,HCPCS,OUTPATIENT,,,682.00,272.80,,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,409.2,60,,327.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,557.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,579.7,85,,463.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,477.4,70,,381.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,579.7,
ED WND RP-INTERMED-scal/arm/lgs >30 cm,11112037,CDM,450,RC,12037,HCPCS,OUTPATIENT,,,1566.00,626.40,,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,939.6,60,,751.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,624.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,1331.1,85,,1064.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,1096.2,70,,876.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,501.12,32,,400.9,percent of total billed charges,32% of total billed charges,419,1331.1,
ED CLD TREAT OF THUMB W/MANIP,11126641,CDM,450,RC,26641,HCPCS,OUTPATIENT,,,1576.00,630.40,,,,,,other ,not seperately reimbursable,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,945.6,60,,756.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,542.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,1339.6,85,,1071.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,1103.2,70,,882.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,504.32,32,,403.46,percent of total billed charges,32% of total billed charges,504.32,1339.6,
"ED ATTCH PDCL GRFT-EYE LDS,NOSE,ERS,10.0",11126642,CDM,450,RC,14060,HCPCS,OUTPATIENT,,,3521.00,1408.40,,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,479,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,2112.6,60,,1690.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,964.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2992.85,85,,2394.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,2464.7,70,,1971.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,1126.72,32,,901.38,percent of total billed charges,32% of total billed charges,479,2992.85,
MINO SURG ER 1-60MIN,11216980,CDM,450,RC,,,OUTPATIENT,,,779.00,311.60,,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.4,60,,373.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,662.15,85,,529.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,545.3,70,,436.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,662.15,
MINO SURG ER EA ADDL HR,11216988,CDM,450,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
ELECTRIC SHOCK (ONE TIME CHG),11300200,CDM,450,RC,90870,HCPCS,OUTPATIENT,,,966.00,386.40,,,,,,other ,not seperately reimbursable,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,579.6,60,,463.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,216.09,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,821.1,85,,656.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,676.2,70,,540.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,309.12,32,,247.3,percent of total billed charges,32% of total billed charges,216.09,821.1,
DEFIBRILLATION (15 MIN),11301869,CDM,450,RC,92960,HCPCS,OUTPATIENT,,,1057.00,422.80,,,,,,other ,not seperately reimbursable,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,634.2,60,,507.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,195.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,898.45,85,,718.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,739.9,70,,591.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,338.24,32,,270.59,percent of total billed charges,32% of total billed charges,195.13,898.45,
ER LEVEL 1-MINIMAL,11302123,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,162.00,64.80,,750,100,,,case rate,pays based on per visit rate,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.2,60,,77.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,113.4,70,,90.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,51.84,32,,41.47,percent of total billed charges,32% of total billed charges,28.33,750,
ER LEVEL 1-MINIMALSUTURE REMOVAL,11302124,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,,,,750,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,750,750,
ER LEVEL 2-ROUTINE,11302131,CDM,450,RC,99282,HCPCS,OUTPATIENT,,,297.00,118.80,,750,100,,,case rate,pays based on per visit rate,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,54.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,54.96,750,
ER LEVEL 3-URGENT,11302149,CDM,450,RC,99283,HCPCS,OUTPATIENT,,,531.00,212.40,,750,100,,,case rate,pays based on per visit rate,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.6,60,,254.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,93.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,451.35,85,,361.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,371.7,70,,297.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,169.92,32,,135.94,percent of total billed charges,32% of total billed charges,93.79,750,
ER LEVEL 4-COMPLEX,11302153,CDM,450,RC,99284,HCPCS,OUTPATIENT,,,885.00,354.00,,750,100,,,case rate,pays based on per visit rate,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,531,60,,424.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,157.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,752.25,85,,601.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,619.5,70,,495.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,157.84,752.25,
ER LEVEL 5-CRITICAL,11302156,CDM,450,RC,99285,HCPCS,OUTPATIENT,,,1317.00,526.80,,750,100,,,case rate,pays based on per visit rate,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,790.2,60,,632.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,229.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,1119.45,85,,895.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,921.9,70,,737.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,421.44,32,,337.15,percent of total billed charges,32% of total billed charges,229.56,1119.45,
TREAT RM ER 1-60MIN,11302159,CDM,761,RC,,,OUTPATIENT,,,313.00,125.20,,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.8,60,,150.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,219.1,70,,175.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,266.05,
CRITICAL CARE FIRST HR,11302160,CDM,450,RC,99291,HCPCS,OUTPATIENT,,,1806.00,722.40,,750,100,,,case rate,pays based on per visit rate,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1083.6,60,,866.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,352.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,1535.1,85,,1228.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,1264.2,70,,1011.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,577.92,32,,462.34,percent of total billed charges,32% of total billed charges,352.11,1535.1,
CONTINUED CARE EMER ROOM / HOUR,11302164,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,364.00,145.60,,1500,100,,,case rate,pays based on per visit rate,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.4,60,,174.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,309.4,85,,247.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,254.8,70,,203.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,116.48,32,,93.18,percent of total billed charges,32% of total billed charges,116.48,1500,
CRITICAL CARE EA ADD'L 30MIN,11302165,CDM,450,RC,99292,HCPCS,OUTPATIENT,,,332.00,132.80,,750,100,,,case rate,pays based on per visit rate,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.2,60,,159.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,155.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,232.4,70,,185.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,32,,84.99,percent of total billed charges,32% of total billed charges,106.24,750,
TREAT RM ER 1-60MIN,11302190,CDM,761,RC,,,OUTPATIENT,,,313.00,125.20,,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.8,60,,150.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,219.1,70,,175.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,266.05,
TREAT RM ER EA ADDL HR,11302195,CDM,761,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
REM OF EMBEDDED FB MOUTH VEST,11302196,CDM,450,RC,40804,HCPCS,OUTPATIENT,,,1690.00,676.00,,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1014,60,,811.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,234.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1183,70,,946.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,234.3,1436.5,
CLSD TX DIST TIB FX WB WO/ANES W/MANI OR,11302200,CDM,450,RC,27825,HCPCS,OUTPATIENT,,,2466.00,986.40,,,,,,other ,not seperately reimbursable,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1479.6,60,,1183.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,706.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,2096.1,85,,1676.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,1726.2,70,,1380.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,789.12,32,,631.3,percent of total billed charges,32% of total billed charges,419,2096.1,
CLSD TX RAD/TIB SHFT FX W/O MANI,11302201,CDM,450,RC,25560,HCPCS,OUTPATIENT,,,445.00,178.00,,,,,,other ,not seperately reimbursable,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267,60,,213.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,372.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,311.5,70,,249.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,142.4,32,,113.92,percent of total billed charges,32% of total billed charges,142.4,378.25,
CLSD TX HUMERAL SHFT FX W/MANI,11302202,CDM,450,RC,24505,HCPCS,OUTPATIENT,,,2714.00,1085.60,,,,,,other ,not seperately reimbursable,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1628.4,60,,1302.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,652.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,2306.9,85,,1845.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,1899.8,70,,1519.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,868.48,32,,694.78,percent of total billed charges,32% of total billed charges,312,2306.9,
DRAINAGE OF SCROTAL WALL ABSCESS,11302203,CDM,450,RC,55100,HCPCS,OUTPATIENT,,,2756.00,1102.40,,,,,,other ,not seperately reimbursable,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1653.6,60,,1322.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,293.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,2342.6,85,,1874.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,1929.2,70,,1543.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,881.92,32,,705.54,percent of total billed charges,32% of total billed charges,293.03,2342.6,
INJ  CORPORA CAVERNOSA W/PHARM AGNT,11302204,CDM,450,RC,54235,HCPCS,OUTPATIENT,,,514.00,205.60,,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.4,60,,246.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,110.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,436.9,85,,349.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,359.8,70,,287.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,110.5,436.9,
NASO/GASTRO TUBE REPLACEMT REQ PHYS,11302205,CDM,450,RC,43752,HCPCS,OUTPATIENT,,,773.00,309.20,,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,463.8,60,,371.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,51.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,541.1,70,,432.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,51.99,657.05,
PLEURAL DRAIN W/TUBE INSERT,11302206,CDM,450,RC,32556,HCPCS,OUTPATIENT,,,3292.00,1316.80,,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1975.2,60,,1580.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,948.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2798.2,85,,2238.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,2304.4,70,,1843.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,1053.44,32,,842.75,percent of total billed charges,32% of total billed charges,948.1,2798.2,
CATH FOR SPEC COLLECTION,11302207,CDM,450,RC,P9612,HCPCS,OUTPATIENT,,,7.50,3.00,,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.5,60,,3.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,6.38,85,,5.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,5.25,70,,4.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,6.38,
REMOVAL OF  FB FOOT (DEEP),11302208,CDM,450,RC,28192,HCPCS,OUTPATIENT,,,3046.00,1218.40,,,,,,other ,not seperately reimbursable,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1827.6,60,,1462.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,574.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,2589.1,85,,2071.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,2132.2,70,,1705.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,974.72,32,,779.78,percent of total billed charges,32% of total billed charges,419,2589.1,
ADMIN COVID VACC 1ST DOSE 30MCG/.3ML (PF,11302209,CDM,771,RC,0001A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADMIN COVID VACC 2ND DOSE 30MCG/.3ML (PF,11302210,CDM,771,RC,0002A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADMIN COVID VACC 1ST DOSE 100MCG/05 ML (,11302211,CDM,771,RC,0011A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ADMIN COVID VACC 2ND DOSE 100MCG/05 ML (,11302212,CDM,771,RC,0012A,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
SUBCU OR IM INJ,13011768,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,16.25,
SUBCU OR IM INJ,13090782,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,16.25,
****OBVS LOW COMPLEXITY,13099218,CDM,762,RC,99218,HCPCS,OUTPATIENT,,,446.00,178.40,,1500,100,,,case rate,pays based on per visit rate,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,123.88,1500,
****OBVS MODERATE COMPLEXITY,13099219,CDM,762,RC,99219,HCPCS,OUTPATIENT,,,446.00,178.40,,1500,100,,,case rate,pays based on per visit rate,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,166.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,1500,
*****OBVS HIGH COMPLEXITY,13099220,CDM,762,RC,99220,HCPCS,OUTPATIENT,,,446.00,178.40,,1500,100,,,case rate,pays based on per visit rate,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,224.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,1500,
****OBVS LOW COMPLEXITY SAME DAY,13099234,CDM,762,RC,99234,HCPCS,OUTPATIENT,,,446.00,178.40,,1500,100,,,case rate,pays based on per visit rate,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,1500,
****OBVS MODERATE COMPLEXITY SAME DAY,13099235,CDM,762,RC,99235,HCPCS,OUTPATIENT,,,446.00,178.40,,1500,100,,,case rate,pays based on per visit rate,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,207.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,1500,
****OBVS HIGH COMPLEXITY SAME DAY,13099236,CDM,762,RC,99236,HCPCS,OUTPATIENT,,,446.00,178.40,,1500,100,,,case rate,pays based on per visit rate,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,266.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,1500,
COBAN 4  STER,15000000,CDM,272,RC,A6454,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
URINARY EXTERNAL CATH,15000002,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
COVADERM 4X10,15000003,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SHILEY TRACH 4LPC,15000004,CDM,272,RC,,,OUTPATIENT,,,557.00,222.80,,,,,,other ,not seperately reimbursable,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,334.2,60,,267.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,473.45,85,,378.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,389.9,70,,311.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,178.24,32,,142.59,percent of total billed charges,32% of total billed charges,178.24,473.45,
DUAL PORT PROTECTOR,15000005,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE GRIPPER,15000006,CDM,272,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
HUBER NEEDLE 22,15000007,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
DRESSING HYDRO BLUE 4X4,15000008,CDM,271,RC,A6210,HCPCS,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,51.68,272,,,fee schedule,272% of BCBS fee schedule,51.68,272,,,fee schedule,272% of BCBS fee schedule,51.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,51.68,
UNI CATH,15000009,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE 3113-81,15000010,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
DRESSING  MEPILEX 6X8,15000011,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
POUCH SURFIT 12-12.5IN,15000012,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
POUCH SURFIT 11IN,15000013,CDM,272,RC,,,OUTPATIENT,,,11.40,4.56,,,,,,other ,not seperately reimbursable,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.84,60,,5.47,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,9.69,85,,7.75,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,7.98,70,,6.38,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,3.65,32,,2.92,percent of total billed charges,32% of total billed charges,3.65,9.69,
NUSTOP CATHER DISPOSAL,15000014,CDM,272,RC,,,OUTPATIENT,,,121.00,48.40,,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.6,60,,58.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,84.7,70,,67.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,102.85,
DRAIN PENROSE 18X1,15000015,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SHILEY 4CFN,15000016,CDM,272,RC,,,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,200.6,
SHILEY 6CFN,15000017,CDM,272,RC,,,OUTPATIENT,,,216.00,86.40,,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,60,,103.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,151.2,70,,120.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,183.6,
SHILEY 8CFN,15000018,CDM,272,RC,,,OUTPATIENT,,,402.00,160.80,,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241.2,60,,192.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,281.4,70,,225.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,341.7,
SHILEY 10CFN,15000019,CDM,272,RC,,,OUTPATIENT,,,405.00,162.00,,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243,60,,194.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,344.25,85,,275.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,283.5,70,,226.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,344.25,
FILTERLINE SET ADLT/PEDI,15000020,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
TUBE SALEM SUMP 12FR,15000021,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
TRAUMA DRESSING 12X30,15000022,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
HEAD IMMOBILIZER STA-BLOCK,15000023,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
SUCTION CANISTER,15000024,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ET TUBE SET 2.5,15000025,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE SET 3.0,15000026,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE SET 3.5,15000027,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE SET 5.0,15000028,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE SET 5.5,15000029,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
DRESSING  MEPILEX 4X4,15000031,CDM,272,RC,A6209,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,19.42,272,,,fee schedule,272% of BCBS fee schedule,19.42,272,,,fee schedule,272% of BCBS fee schedule,19.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,19.42,
ET TUBE SET 7.0,15000032,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
ET TUBE SET 7.5,15000033,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
ET TUBE SET 8.5,15000034,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
ET TUBE SET 9.0,15000035,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
VENIGUARD DRESSING,15000036,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ET TUBE SET 8.0,15000037,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
DRAIN EXPRESS,15000038,CDM,272,RC,,,OUTPATIENT,,,183.00,73.20,,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.8,60,,87.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,128.1,70,,102.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,155.55,
SHILEY 4CFS,15000039,CDM,272,RC,,,OUTPATIENT,,,376.00,150.40,,,,,,other ,not seperately reimbursable,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.6,60,,180.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,263.2,70,,210.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,120.32,32,,96.26,percent of total billed charges,32% of total billed charges,120.32,319.6,
DERMA GEL 4X4 WAFER,15000040,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PEDIATRIC 2-LUMEN 4FR,15000041,CDM,272,RC,,,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
DRESSING OPTIFOAM AG 6X6,15000042,CDM,272,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
DRESSING BARIER ACTICOAT,15000043,CDM,272,RC,A9270,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
DRESSING HYDRO BLUE 6X6,15000044,CDM,271,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
DRESSING MEPILEX AG 4X8,15000045,CDM,272,RC,,,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,39.95,
DRESSING MEPILEX 8X8,15000046,CDM,272,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
DRESSING OPTICELL AG,15000047,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CLAMP CORD DISP STERILE,15000048,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRESSING  MEPILEX 6X6,15000049,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
NEG PRESS WOUND THER DSG KIT,15000051,CDM,272,RC,A6550,HCPCS,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
DRESSING  MESALT,15000052,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
DRESSING PURACOL,15000053,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
DRESSING OPTICEL,15000054,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
DRESSING VERSATEL 4X5,15000055,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
STERI DRAPE,15000061,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
RUMAN 3 CM,15000062,CDM,272,RC,,,OUTPATIENT,,,19.90,7.96,,,,,,other ,not seperately reimbursable,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.94,60,,9.55,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,16.92,85,,13.54,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,13.93,70,,11.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,6.37,32,,5.1,percent of total billed charges,32% of total billed charges,6.37,16.92,
RUMAN 4 CM,15000063,CDM,272,RC,,,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
RUMAN 5.5 CM,15000064,CDM,272,RC,,,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
ANTERIOR 4.5 CM,15000065,CDM,272,RC,,,OUTPATIENT,,,102.00,40.80,,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,60,,48.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,86.7,
ANTERIOR 5.5 CM,15000067,CDM,272,RC,,,OUTPATIENT,,,137.00,54.80,,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,116.45,
G TUBE LOW PROFILE 20FR,15000068,CDM,272,RC,,,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
G TUBE LOW PROFILE 24FR,15000069,CDM,272,RC,,,OUTPATIENT,,,245.00,98.00,,,,,,other ,not seperately reimbursable,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147,60,,117.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,171.5,70,,137.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,78.4,32,,62.72,percent of total billed charges,32% of total billed charges,78.4,208.25,
CATH THORA 24FR,15000071,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
POUCH UROSTOMY,15000072,CDM,271,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
DRESSING MAXSORB,15000073,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
DRESSING SILVASORB,15000074,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
DRESSING AQUACEL EXTRA,15000075,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
STOMAHESIVE POWDER,15000076,CDM,271,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
EAKIN COHESIVE,15000077,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ADAPT,15000078,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
THERAHONEY SHEET,15000079,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
THERAHONEY SHEET,15000080,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CATH TROCAR 12FR,15000081,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
DRESSING KALOSTAT,15000082,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
MARATHON SKIN PRTECTANT,15000083,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SILVASORB GEL,15000084,CDM,272,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
KLING 4,15000085,CDM,272,RC,A6449,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GASTROSTOMY/JEJUNOSTOMY TUBE,15000086,CDM,272,RC,B4087,HCPCS,OUTPATIENT,,,383.00,153.20,,,,,,other ,not seperately reimbursable,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.8,60,,183.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,268.1,70,,214.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,122.56,32,,98.05,percent of total billed charges,32% of total billed charges,44.99,325.55,
ET TUBE SET 6.5,15000087,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
COMPRESSION SYSEM 4 LAYER,15000088,CDM,272,RC,A6441,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
BENZOIN TINCTURE STERI STRIP,15000089,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NUGAUZE PLAIN 1/2,15000090,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DRESSING ACTICOST FLEX,15000091,CDM,272,RC,A6207,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,19.04,272,,,fee schedule,272% of BCBS fee schedule,19.04,272,,,fee schedule,272% of BCBS fee schedule,19.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,19.04,
SUTURE 8682G,15000092,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SUTURE 585H,15000093,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
DRESSING PROMOGRAN,15000094,CDM,272,RC,A6021,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
DRESSING QWICK,15000095,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
SURFIT POUCH,15000096,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SURFIT POUCH,15000097,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
THERAHONEY,15000098,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
FILTERLINE SET ADLT/PEDI,15000100,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
DRESSING ALLEVYN SACRUM,15000101,CDM,272,RC,A6213,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
DRESSING FOAM TEGADERM,15000102,CDM,272,RC,A6212,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,25.16,272,,,fee schedule,272% of BCBS fee schedule,25.16,272,,,fee schedule,272% of BCBS fee schedule,25.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,25.16,
SAME AS #15000108,15000103,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MASK ADULT VENTI,15000104,CDM,271,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
DRESSING FOAM TEGADERM,15000105,CDM,272,RC,A6212,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,25.16,272,,,fee schedule,272% of BCBS fee schedule,25.16,272,,,fee schedule,272% of BCBS fee schedule,25.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,25.16,
DRESSING MELGISORB,15000106,CDM,272,RC,A6196,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,19.07,272,,,fee schedule,272% of BCBS fee schedule,19.07,272,,,fee schedule,272% of BCBS fee schedule,19.07,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,19.07,
BARRIER CAVILON SPRAY,15000108,CDM,272,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18,40,,14.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
DRESSING XTRA SORB,15000109,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
DRESSING SORBACT,15000110,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
COMPRESSION SYSEM 2 LAYER,15000111,CDM,272,RC,A6454,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
CATH RECTAL 18FR,15000112,CDM,272,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
COFLEX TLC 2 LAYER,15000113,CDM,272,RC,A6454,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
COFLEX TLC LITE,15000114,CDM,272,RC,A6454,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
COFLEX TLC ZINC,15000115,CDM,272,RC,A6454,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
COFLEX TLC LITE,15000116,CDM,272,RC,A6454,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
DRESSING  VERSATEL 2X3,15000117,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
DRESSING  IOPLEX 2x2,15000118,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
DRESSING  IOPLEX 4x5,15000119,CDM,272,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
DRESSING ADAPTIC 3X3,15000122,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SLEEVE SCD LRG,15000123,CDM,271,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
BARD FILIFORM 4FR,15000124,CDM,272,RC,,,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
BARD FILIFORM 10FR,15000125,CDM,272,RC,,,OUTPATIENT,,,545.00,218.00,,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327,60,,261.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,463.25,85,,370.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,381.5,70,,305.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,463.25,
BARD FILIFORM 12FR,15000126,CDM,272,RC,,,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,255,
BARD FILIFORM 14FR,15000127,CDM,272,RC,,,OUTPATIENT,,,301.00,120.40,,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.6,60,,144.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,210.7,70,,168.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,255.85,
BARD FILIFORM 16FR,15000128,CDM,272,RC,,,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,255,
BARD FILIFORM 18FR,15000129,CDM,272,RC,,,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,255,
DRESSING ADAPTIC 3X8,15000130,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BARD FILIFORM 22FR,15000131,CDM,272,RC,,,OUTPATIENT,,,545.00,218.00,,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327,60,,261.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,463.25,85,,370.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,381.5,70,,305.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,463.25,
BARD FILIFORM 24FR,15000132,CDM,272,RC,,,OUTPATIENT,,,545.00,218.00,,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327,60,,261.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,463.25,85,,370.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,381.5,70,,305.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,32,,139.52,percent of total billed charges,32% of total billed charges,174.4,463.25,
TISSEEL SELANT KIT,15000133,CDM,272,RC,,,OUTPATIENT,,,404.00,161.60,,,,,,other ,not seperately reimbursable,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.4,60,,193.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,282.8,70,,226.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,129.28,32,,103.42,percent of total billed charges,32% of total billed charges,129.28,343.4,
SLEEVE BARATRIC,15000134,CDM,271,RC,,,OUTPATIENT,,,225.00,90.00,,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135,60,,108,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,157.5,70,,126,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,191.25,
DRESSING MAXORB II,15000137,CDM,272,RC,A6207,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,19.04,272,,,fee schedule,272% of BCBS fee schedule,19.04,272,,,fee schedule,272% of BCBS fee schedule,19.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,19.04,
SCD SLEEVE  CALF LRG,15000138,CDM,271,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
SCD SLEEVE  CALF MED,15000139,CDM,271,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
SCD SLEEVE LRG SINGLE,15000140,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
SLEEVE THIGH REGULAR SINGLE,15000141,CDM,271,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
FEMALE CATH KIT,15000142,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
SAME AS #15000176,15000143,CDM,272,RC,A6213,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
BAG REPLACEMENT FOR DIGNISHIELD,15000144,CDM,272,RC,,,OUTPATIENT,,,10.48,4.19,,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.29,60,,5.03,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,8.91,85,,7.13,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,7.34,70,,5.87,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,32,,2.68,percent of total billed charges,32% of total billed charges,3.35,8.91,
DIGNISHIELD SYSTEM,15000145,CDM,272,RC,,,OUTPATIENT,,,1281.00,512.40,,,,,,other ,not seperately reimbursable,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,768.6,60,,614.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,1088.85,85,,871.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,896.7,70,,717.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,409.92,32,,327.94,percent of total billed charges,32% of total billed charges,409.92,1088.85,
DRESSING AQUACEL AG,15000146,CDM,272,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
SILVASORB GEL,15000153,CDM,272,RC,A6213,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
SHOE HEEL WEDGE,15000154,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
SHOE HEEL WEDGE XL,15000155,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
SHOE WEDGE M,15000156,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
SHOE WEDGE XL,15000157,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
DRESSING ALLEVYN HEEL,15000158,CDM,272,RC,A6213,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
DRESSING PICO 10X20,15000159,CDM,272,RC,Q4186,HCPCS,OUTPATIENT,,,677.00,270.80,,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406.2,60,,324.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,473.9,70,,379.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,575.45,
DRESSING PICO 15X15,15000160,CDM,272,RC,Q4186,HCPCS,OUTPATIENT,,,677.00,270.80,,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406.2,60,,324.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,575.45,85,,460.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,473.9,70,,379.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,32,,173.31,percent of total billed charges,32% of total billed charges,216.64,575.45,
G TUBE LOW PROFILE 22FR,15000161,CDM,272,RC,,,OUTPATIENT,,,238.00,95.20,,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.8,60,,114.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,166.6,70,,133.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,202.3,
ANTIBACTRIAL DRESSING 5X6,15000162,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ANTIBACTRIAL DRESSING 10X20,15000163,CDM,272,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
ANTIBACTRIAL DRESSING 10X12,15000164,CDM,272,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
ANTIBACTRIAL DRESSING 10X12,15000165,CDM,272,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
DRESSING PICO 10X30,15000166,CDM,272,RC,Q4186,HCPCS,OUTPATIENT,,,800.00,320.00,,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,60,,384,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,560,70,,448,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,680,
DRESSING PICO 10X40,15000167,CDM,272,RC,Q4186,HCPCS,OUTPATIENT,,,800.00,320.00,,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,60,,384,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,560,70,,448,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,680,
DRESSING PICO 10x20,15000168,CDM,272,RC,Q4186,HCPCS,OUTPATIENT,,,800.00,320.00,,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,60,,384,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,560,70,,448,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,32,,204.8,percent of total billed charges,32% of total billed charges,256,680,
SHOE HEEL WEDGE LARGE,15000169,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
SHOE ORTHO XL,15000170,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
SHOE ORTHO LARGE,15000171,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
CHEST TUBE TRAY,15000172,CDM,272,RC,Q4186,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
DRESSING MEDIHONEY 4X5,15000173,CDM,272,RC,A6021,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,50.15,
ROOKE VASCULAR BOOT,15000174,CDM,272,RC,A6021,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,50.15,
14MM ROUND,15000175,CDM,272,RC,A6021,HCPCS,OUTPATIENT,,,1128.00,451.20,,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676.8,60,,541.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,958.8,85,,767.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,789.6,70,,631.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,32,,288.77,percent of total billed charges,32% of total billed charges,360.96,958.8,
DRESSING OPTIFOAM 5X5,15000176,CDM,272,RC,A6213,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DRESSING VERSATEL 8X12,15000177,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
MALE CATH KIT 5FR,15000178,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MALE CATH KIT 8FR,15000179,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SHOE ORTHO WEDGE SML,15000181,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
SHOE ORTHO WEDGE MED,15000182,CDM,271,RC,L3260,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DUCANTO CATH,15000183,CDM,271,RC,,,OUTPATIENT,,,12.10,4.84,,,,,,other ,not seperately reimbursable,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.26,60,,5.81,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,10.29,85,,8.23,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,8.47,70,,6.78,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,3.87,32,,3.1,percent of total billed charges,32% of total billed charges,3.87,10.29,
PURWICK MALE,15000184,CDM,272,RC,,,OUTPATIENT,,,77.00,30.80,,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.2,60,,36.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,53.9,70,,43.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,65.45,
STOMAHESIVE ADHESIVE POWDER,15000185,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
STOMAHESIVE SEAL 4,15000186,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
POUCH ONE PIECE,15000187,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BARRIER RING SML,15000188,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BARRIER RING LRG,15000189,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRESSING ALLEVYN LIFE,15000190,CDM,272,RC,A6213,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
HIP ABDUCTION PILLOW,15000339,CDM,272,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
COLD THERAPY UNIT,15000340,CDM,271,RC,,,OUTPATIENT,,,323.00,129.20,,,,,,other ,not seperately reimbursable,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.8,60,,155.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,226.1,70,,180.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,103.36,32,,82.69,percent of total billed charges,32% of total billed charges,103.36,274.55,
COLD THERAPY BLANKET,15000341,CDM,271,RC,,,OUTPATIENT,,,121.00,48.40,,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.6,60,,58.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,84.7,70,,67.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,102.85,
DRESSING AQUACEL BURN,15000342,CDM,272,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
SPLINT WRIST/FOREARM,15000345,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
SPLINT FOAM MED,15000346,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
SUCTION SWABS,15000360,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AL FING SPLINTS 1/2X9,15000379,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AL FING SPLINTS 3/4X18,15000380,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUPPORTER-X-LG,15000382,CDM,272,RC,,,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
LINER CANISTER 1500CC,15000388,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRESSING ALGINATE AG,15000389,CDM,272,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
DRESSING AQUACEL 4X4,15000391,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
DRESSING ACTICOAT MOISTURE CONTROL,15000392,CDM,272,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
INFANT CATH KIT,15000393,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
COLLAR ADJ ADULT,15000394,CDM,274,RC,L0172,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
INST PACK DISP HEMO,15000401,CDM,272,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
HOSE KNEE-XLG,15000450,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HOSE KNEE-2XL,15000451,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HOSE KNEE-3XL,15000452,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
HOSE KNEE MED,15000477,CDM,271,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
HOSE KNEE-LRG,15000478,CDM,271,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HOSE KNEE-SML,15000479,CDM,271,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SHILEY TRACH 8 FEN,15000480,CDM,272,RC,,,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,107.1,
POWER LOC SAFETY INFUSION SET 20,15000512,CDM,272,RC,,,OUTPATIENT,,,17.88,7.15,,,,,,other ,not seperately reimbursable,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.73,60,,8.58,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,15.2,85,,12.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,12.52,70,,10.02,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,5.72,32,,4.58,percent of total billed charges,32% of total billed charges,5.72,15.2,
LMA SIZE 1,15000514,CDM,272,RC,,,OUTPATIENT,,,195.00,78.00,,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117,60,,93.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,165.75,
LMA SIZE 5,15000515,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
LMA SIZE 3,15000516,CDM,272,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
LMA SIZE 4,15000517,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
TONSIL SPONGE,15000520,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
SUTURE AR-7200,15000521,CDM,272,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
SUTURE AR-7211,15000522,CDM,272,RC,,,OUTPATIENT,,,142.00,56.80,,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.2,60,,68.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,120.7,
SUTURE J212H,15000523,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
COLLAR PEDI,15000525,CDM,274,RC,L0172,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
WAFER SURFIT,15000526,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
POUCH ACTIVE,15000527,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LMA SIZE 2,15000528,CDM,272,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
HOSE THIGH 2XL,15000529,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
HOSE THIGH 3XL,15000530,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
SUTURE AR-7220,15000531,CDM,272,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
GRAFT FLEXI,15000532,CDM,278,RC,,,OUTPATIENT,,,6837.00,2734.80,,2734.8,40,,,percent of total billed charges,40% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4102.2,60,,3281.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,5811.45,85,,4649.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,4785.9,70,,3828.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,32,,1750.27,percent of total billed charges,32% of total billed charges,2187.84,5811.45,
IOBAN ANTIMICROBIAL INCISE DRAPE,15000533,CDM,272,RC,,,OUTPATIENT,,,31.00,12.40,,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.6,60,,14.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,26.35,
HUBER NEEDLE 22g,15000535,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
GLIDESCOPE MAC S4,15000537,CDM,272,RC,,,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
GLIDESCOPE LoPro s3,15000538,CDM,272,RC,,,OUTPATIENT,,,115.00,46.00,,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,97.75,
GLIDESCOPE LoPro s4,15000539,CDM,272,RC,,,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
GLIDESCOPE MAC S3,15000540,CDM,272,RC,,,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,98.6,
STYLET RIGID MED,15000541,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
STYLET RIGID LRG,15000542,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
STYLET RIGID SML,15000543,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
HOSE SOFT THIGH OT SILICONE,15000546,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SILICONE,15000547,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SILICONE,15000548,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SILICONE,15000549,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SILICONE,15000550,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SHORT,15000551,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SHORT,15000552,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SHORT,15000553,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SHORT,15000554,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
HOSE SOFT THIGH OT SHORT,15000555,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
LITTLE SUCKER DEVICE,15000558,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
FOURFLEX BANDAGE SYSTEM,15000560,CDM,272,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
LMA SIZE 2.5,15000561,CDM,272,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
BETADINE SOLUTION 4OZ,15000932,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SWABSTICK BETADINE,15000940,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
KNEE IMMO SML,15001063,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
URINE OUTPUT,15001095,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TRAY BONE MARROW,15001229,CDM,272,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
CHEST DRAIN VALVE(HEIMLICK),15001430,CDM,272,RC,,,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,204,
CAUTERY PENCIL,15001468,CDM,272,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
MAMMATOME MULTI PROBE,15001469,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
MAMMATOME VACUUM CANISTER,15001470,CDM,272,RC,,,OUTPATIENT,,,619.00,247.60,,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.4,60,,297.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,526.15,85,,420.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,433.3,70,,346.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,526.15,
MAMMATOME VACUUM TUBING,15001471,CDM,272,RC,,,OUTPATIENT,,,619.00,247.60,,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.4,60,,297.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,526.15,85,,420.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,433.3,70,,346.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,526.15,
MAMMATOME SURGICAL TRAY,15001472,CDM,272,RC,,,OUTPATIENT,,,619.00,247.60,,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.4,60,,297.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,526.15,85,,420.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,433.3,70,,346.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,526.15,
MAMMATOME PROBE GUIDE,15001474,CDM,272,RC,,,OUTPATIENT,,,619.00,247.60,,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.4,60,,297.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,526.15,85,,420.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,433.3,70,,346.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,32,,158.46,percent of total billed charges,32% of total billed charges,198.08,526.15,
CATH FOLEY 12FR 30CC,15001484,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CATH TROCAR 20FR,15001518,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
CATH TROCAR 28,15001526,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
CATHETER - MUSHROOM #24,15001542,CDM,272,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
CATHETER - MUSHROOM #26,15001559,CDM,272,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
CATHETER - RADIAL ARTERY 20G,15001564,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
CATHETER CVP KIT #16 - ARROW,15001591,CDM,272,RC,,,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
COLLAR EXO-STATIC - SM,15001617,CDM,272,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
EXO-STATIC W/CHIN PIECE MED,15001625,CDM,272,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
CERV COLLAR 2.5X14 PEDIATRIC,15001630,CDM,274,RC,L0120,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
CERV COLLAR 4X17,15001631,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
EXO-STATIC W/CHIN PEICE LRG/COLLAR EXO-S,15001633,CDM,272,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
CERIFORM COLLAR,15001658,CDM,274,RC,L0120,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
CATH THORA 28FR,15001716,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
CATH THORA 32FR,15001724,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
CATH THORA 36FR,15001726,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
CATH-ARROW PERCUTANEOUS KIT #8,15001765,CDM,272,RC,,,OUTPATIENT,,,98.00,39.20,,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.8,60,,47.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,68.6,70,,54.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,83.3,
CATH SECURE,15001773,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CATH HEMODIALYSIS/PERITONEAL SHORT TERM,15001781,CDM,272,RC,C1752,HCPCS,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
PARACENTISIS,15001790,CDM,272,RC,,,OUTPATIENT,,,171.00,68.40,,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.6,60,,82.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,119.7,70,,95.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,145.35,
CATH COUDE 14FR,15001815,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
CATH COUDE 16FR,15001816,CDM,272,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
CATH COUDE 18FR,15001817,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
COBAN 3  STER,15001915,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TIP-INTRO PNEUMOTHORAX SET W/HYDRO COATI,15002000,CDM,272,RC,,,OUTPATIENT,,,572.00,228.80,,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,343.2,60,,274.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.8,40,,183.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,486.2,85,,388.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,400.4,70,,320.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,32,,146.43,percent of total billed charges,32% of total billed charges,183.04,486.2,
CATH DRAINAGE 8FR,15002013,CDM,272,RC,C1729,HCPCS,OUTPATIENT,,,394.00,157.60,,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.4,60,,189.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,157.6,40,,126.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,275.8,70,,220.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,32,,100.86,percent of total billed charges,32% of total billed charges,126.08,334.9,
TRU CORE BIOP INST,15002021,CDM,272,RC,,,OUTPATIENT,,,102.00,40.80,,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,60,,48.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40.8,40,,32.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,86.7,
QUICK CORE NDLE,15002026,CDM,272,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
QUICK CORE NDLE 20G,15002027,CDM,272,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
JAB DUCT CANNULA,15002029,CDM,272,RC,,,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
SPINAL NEEDLE 22G,15002032,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
RABINOV SET,15002037,CDM,272,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
QUICK CORE NDLE 18G,15002038,CDM,272,RC,,,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,59.6,40,,47.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,126.65,
PNEUMO KIT 8FR,15002039,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
ELASTOPLAST 4,15002116,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
BILI BLANKET,15002117,CDM,272,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
ELECTRODES COMBO,15002134,CDM,271,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
BANDAGE KERLIX,15002157,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BANDAGE KLING 2,15002173,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BANDAGE KLING 3,15002181,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STERI-STRIP 1/2X4,15002272,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STERI-STRIP 1/4X4,15002274,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BANDAGE UNNA BOOT,15002298,CDM,271,RC,A6456,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
PACK COLD INSTANT,15002314,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
INTERLINK INJECTION SITE,15002496,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MINI SPIKE - PROPOFOL SPIKE,15002497,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
VIAL-MATE ADAPTER 2B8071,15002498,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STETHOSCOPE DISP,15002539,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BONE MARROW NEEDLE 15G,15002561,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
DRESSING  DUODERM 4X4,15002649,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DRESSING  DUODERM 4X4 THIN,15002650,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
DRESSING  MEPILEX AG BORDER 4X4,15002656,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
PAD IODOFLEX 5X5,15002657,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
KIT SUCTION CATH KIT,15002728,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH SUCT 5FR,15002769,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH SUCT 8F,15002777,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH SUCT 10FR,15002785,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH FOLEY 22FR 30CC,15002793,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CATH SUCT 14FR,15002794,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUCT YANKAUER,15002892,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATHETER - TRACAR 10FR,15002934,CDM,272,RC,,,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,79.9,
TUBE FEEDING #5 - ENTRIFLEX 12FR 43,15002975,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FEEDING TUBE #8,15002983,CDM,272,RC,,,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
TUBE NASO FEEDING,15002984,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
TUBE SALEM SUMP 16FR,15002986,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
TUBE SALEM SUMP 18FR,15002994,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
PAD ABD 5X9,15003015,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PAD ABD 8X10,15003023,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BED AERO-MAT SYSTEM,15003025,CDM,291,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
ET TUBE CUFFED 8.5MM,15003160,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
OWENS DRESSING,15003239,CDM,272,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
SIGMOIDOSCOPY SUCTION,15003257,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SIGMOID SPECULUM,15003265,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SPONGE GAUZE 4X4 STER,15003270,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SKIN STAPLER 35W,15003315,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
CATH INTRAUTERINE,15003316,CDM,272,RC,,,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
OB PACK,15003317,CDM,271,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
UMBILICAL VENOUS CATH KIT,15003319,CDM,271,RC,,,OUTPATIENT,,,176.00,70.40,,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,60,,84.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,123.2,70,,98.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,32,,45.06,percent of total billed charges,32% of total billed charges,56.32,149.6,
SKIN STAPLER 35R,15003320,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
DRESS TEGADERM 20cm X 30cm 1629W,15003322,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
URETHERAL FOLLOWER 10FR,15003323,CDM,272,RC,,,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
URETHERAL FOLLOWER 12FR,15003325,CDM,272,RC,,,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
URETHERAL FALLAWER 24FR,15003326,CDM,272,RC,,,OUTPATIENT,,,102.00,40.80,,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,60,,48.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,86.7,
URETERAL FILIFORM 3FR,15003327,CDM,272,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
URETERAL FILIFORM 4FR,15003328,CDM,272,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
URETERAL FILIFORM 5FR,15003329,CDM,272,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
URETERAL FILIFORM 6FR,15003330,CDM,272,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
TRANSDUCER BELT,15003331,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ENDOTRACHEAL TUBE 2 5 EA,15003332,CDM,272,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
URETERAL FOLLOWER 8FR,15003334,CDM,272,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
BLANKET PEDI,15003335,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
PAD TELFA 3X4 STER 7643,15003337,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TELFA PAD 3X8,15003338,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TELFA PAD 3X4 STER,15003339,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ET TUBE CUFFED 3.0MM,15003340,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
HOT PACK,15003342,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PERRI BOTTLES,15003344,CDM,133,RC,,,INPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,4.2,2711,
ASPIRATOR MECONM,15003346,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
ET TUBE CUFFED 4.0MM,15003357,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
GAUZE VASELINE 1/2X72,15003360,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GAUZE VASELINE 1X8,15003361,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GAUZE VASELINE 3X9 STER,15003362,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GAUZE VASELINE 3X18 STER,15003363,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ET TUBE CUFFED 5.0MM,15003365,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE CUFFED 5.5MM,15003366,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
STOPCOCK 4-WAY,15003368,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ET TUBE CUFFED 6.0MM,15003373,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
ET TUBE 6 5,15003381,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
ET TUBE CUFFED 7.0MM,15003399,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ET TUBE CUFFED 7.5MM,15003407,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE CUFFED 8.0MM,15003415,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE 9 0,15003431,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
SWAPSTICK BENZOIN,15003450,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
G TUBE 18FR/FEEDING,15003467,CDM,272,RC,,,OUTPATIENT,,,198.00,79.20,,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.8,60,,95.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,168.3,
SPONGE GAUZE 4X4 STER,15003471,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SPLINT SHORT LEG MED,15003505,CDM,274,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
SPLINT SHORT LEG LRG,15003506,CDM,274,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
SPLINT ALUM SHORT LEG SM,15003507,CDM,274,RC,,,OUTPATIENT,,,77.00,30.80,,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.2,60,,36.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,53.9,70,,43.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,65.45,
SPLINT ALUM LONG LEG SML,15003509,CDM,274,RC,,,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,82.45,
SPLINT ALUM FULL LEG-MED,15003521,CDM,272,RC,,,OUTPATIENT,,,69.16,27.66,,,,,,other ,not seperately reimbursable,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.5,60,,33.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,58.79,85,,47.03,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,48.41,70,,38.73,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,22.13,32,,17.7,percent of total billed charges,32% of total billed charges,22.13,58.79,
SPLINT ALUM FULL LEG-LRG,15003522,CDM,272,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
FEEDING TUBE 5,15003536,CDM,272,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
FRED ANTI-FOG KIT,15003540,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STOMAHESIVE PASTE TUBE,15003554,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
EASI LAV CODE BLUE,15003555,CDM,272,RC,,,OUTPATIENT,,,131.00,52.40,,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,111.35,
WAFER SURFIT 4X4,15003562,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
EVACUATED CONTAINER 1000ML,15003563,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
WAFER SURFIT 5X5,15003570,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
WAFER SURFIT,15003571,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LEVIN TUBE 18FR,15003574,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
LEVIN TUBE 12FR      ),15003575,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
LEVIN TUBE 16FR,15003576,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
LEVIN TUBE 14FR,15003577,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
LEG BAG,15003585,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
STOPCOCK,15003588,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PUNCH BIOPSY 8MM,15003589,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PUNCH BIOPSY 5MM,15003591,CDM,272,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
PUNCH BIOPSY 3.5MM,15003592,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PUNCH BIOPSY 3MM,15003593,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CURETTES 5MM,15003594,CDM,272,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
POUCH ACTIVE LIFE,15003596,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DRAIN PENROSE 12X5/8,15003601,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DRAIN PENROSE 12X1/2,15003602,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DRAIN PENROSE 18X1/4,15003603,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
LEVIN TUBE 8FR,15003605,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH SUCT 18FR,15003612,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PLEURO-EVAC,15003619,CDM,272,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
PAD EYE,15003621,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
EYE IRRIG MORGAN FLOW LENS,15003639,CDM,272,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
EYE SHIELD ALUM FOX,15003647,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
POUCH SURFIT 2 1/2,15003653,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
EAR SURGICAL SPONGE (WICK),15003654,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SHILEY 6CFS,15003672,CDM,272,RC,,,OUTPATIENT,,,284.00,113.60,,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.4,60,,136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,241.4,85,,193.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,198.8,70,,159.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,241.4,
SHILEY TRACH TUBE CUFFLESS 8CFS,15003673,CDM,272,RC,,,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
SHILEY 6DCFN,15003674,CDM,272,RC,,,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
SHILEY 8CFS,15003677,CDM,272,RC,,,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,79.05,
POUCH SURFIT 2 3/4,15003679,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
POUCH SURFIT 4,15003687,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
URIMETER 200ML,15003692,CDM,271,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
SURFIT POUCH 1 3/4,15003705,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUR-FIT FLEX TAN COLLAR 4X4 1 3/4,15003709,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
WAFER SURFIT 1 3/4,15003710,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ANOSCOPE DISP,15003715,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRAIN UNIT W/BG BEL GUARD,15003718,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
WAFER SURFIT 4,15003729,CDM,271,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
HOSE THIGH LRG,15004021,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
HOSE THIGH MED,15004022,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
HOSE THIGH SML,15004023,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
HOSE THIGH XLRG,15004024,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
SUTURE 1665G,15004032,CDM,272,RC,,,OUTPATIENT,,,11.02,4.41,,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.61,60,,5.29,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,9.37,85,,7.5,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,7.71,70,,6.17,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,9.37,
SUTURE 1667G,15004057,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CATH FOLEY 8 FR,15004058,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SUTURE 663G,15004065,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CATHETER TRAY FOLEY BSD 14F,15004066,CDM,272,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
CATH FOLEY 12FR,15004074,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CATH FOLEY 10FR,15004075,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
CATH FOLEY 14FR 30CC,15004082,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CATH SUCT 16FR,15004083,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
HOSE KNEE X-SMALL,15004085,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
SHOE SURG-MEN XLG,15004087,CDM,271,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SHOE SURG-MEN SM,15004088,CDM,271,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CATH FOLEY 16F,15004090,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CATH FOLEY 16F 30CC,15004091,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SURGICEL 4X8,15004097,CDM,272,RC,,,OUTPATIENT,,,387.00,154.80,,,,,,other ,not seperately reimbursable,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,232.2,60,,185.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,270.9,70,,216.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,123.84,32,,99.07,percent of total billed charges,32% of total billed charges,123.84,328.95,
SURGICEL 2X14,15004098,CDM,272,RC,,,OUTPATIENT,,,361.00,144.40,,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.6,60,,173.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,252.7,70,,202.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,306.85,
CATH FOLEY 18F,15004108,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CATH FOLEY 20F 30CC,15004116,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CATH FOLEY 24FR,15004132,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CATH FOLEY 24FR 30CC,15004133,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CATH FOLEY 26FR 30CC,15004140,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CALCULI STRAINER,15004146,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH FOLEY 28FR 30CC,15004157,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CATH FOLEY 30F,15004165,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CATH FOLEY 32F,15004173,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH FOLEY 20FR,15004180,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TOAD FINGER SPLINTS SM,15004181,CDM,271,RC,,,OUTPATIENT,,,5.50,2.20,,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.3,60,,2.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,4.68,85,,3.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,3.85,70,,3.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,4.68,
COLLAR STATNECK XL NO NECK NAVY,15004186,CDM,272,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
COLLAR STATNECK PED2.2RED,15004189,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
COLLAR PERFIT ACE ADJ,15004190,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
TOAD FINGER SPLINTS MED,15004199,CDM,272,RC,,,OUTPATIENT,,,5.50,2.20,,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.3,60,,2.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,4.68,85,,3.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,3.85,70,,3.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,4.68,
TOAD FINGER SPLINTS LG,15004207,CDM,272,RC,,,OUTPATIENT,,,5.50,2.20,,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.3,60,,2.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,4.68,85,,3.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,3.85,70,,3.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,4.68,
SUTURE 1666H,15004230,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CATH EXT SINGLE,15004270,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
INTERLINK CATH EXT (DOUBLE),15004273,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SUTURE 1698G,15004297,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CUFF BLOOD PRESSURE THIGH,15004485,CDM,271,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12,40,,9.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
GUIDE WIRE,15004490,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
AIRWAY ORAL 70MM,15004493,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
GUIDE WIRE,15004494,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,160.00,64.00,,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
GELIFOAM SPONGE SIZE 12  7MM,15004496,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
ENEMA FLEETS MINERAL OIL,15004534,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE G122H,15004560,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DRESS TEGADERM 1882Z,15004562,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRESS TEGADERM 3 1/2x4 1/2,15004563,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRESS TEGADERM 1683Z,15004569,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PRESSURE MONITORING KIT W/TRU-WAVE/,15004589,CDM,272,RC,,,OUTPATIENT,,,254.00,101.60,,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.4,60,,121.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,101.6,40,,81.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,177.8,70,,142.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,215.9,
MONTGOMERY STRAP,15004591,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
ZISCONTINUED 010105,15004597,CDM,271,RC,,,OUTPATIENT,,,859.00,343.60,,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,515.4,60,,412.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,343.6,40,,274.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,730.15,85,,584.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,601.3,70,,481.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,32,,219.9,percent of total billed charges,32% of total billed charges,274.88,730.15,
ENEMA BAG,15004716,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STYLET 5FR,15004717,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CATH UMBILICAL CORD 2.5 FR   88-160325,15004718,CDM,272,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
TRAY UMBILICAL CORD 3.5 FR   88-160333,15004719,CDM,272,RC,,,OUTPATIENT,,,202.00,80.80,,,,,,other ,not seperately reimbursable,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.2,60,,96.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,80.8,40,,64.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,141.4,70,,113.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,64.64,32,,51.71,percent of total billed charges,32% of total billed charges,64.64,171.7,
ENEMA PHOS,15004732,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PROTECTOR HEEL/ELBOW KODEL,15004856,CDM,271,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
HEMOCOILS (BLOOD),15005034,CDM,272,RC,,,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
ZISCONTINUED 010105,15005063,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CARDIAC MONITORONG - ER,15005091,CDM,272,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
SUTURE J214H,15005095,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE SPINAL 22X1 1/2,15005100,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE SPINAL 20X3 1/2,15005101,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NEEDLE SPINAL 22X3 1/2,15005102,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE SPINAL 25X3 1/2,15005103,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE SPINAL 18 X 31/2,15005105,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
NEEDLE SPINAL 22X2 1/2,15005106,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SET BLOOD/FLUID WARMNG,15005107,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
CARDIOPULMONARY RESUSCITATION,15005109,CDM,489,RC,92950,HCPCS,OUTPATIENT,,,779.00,311.60,,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.4,60,,373.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,662.15,85,,529.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,545.3,70,,436.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,662.15,
EZ-IO NEEDLE 25MM,15005111,CDM,489,RC,,,OUTPATIENT,,,392.15,156.86,,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.29,60,,188.23,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.86,40,,125.49,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,333.33,85,,266.66,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,274.51,70,,219.61,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,333.33,
SUTURE JJ42G,15005112,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14,40,,11.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
SUTURE 1698G,15005113,CDM,272,RC,,,OUTPATIENT,,,9.30,3.72,,,,,,other ,not seperately reimbursable,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.58,60,,4.46,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.72,40,,2.98,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,7.91,85,,6.33,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,6.51,70,,5.21,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,2.98,32,,2.38,percent of total billed charges,32% of total billed charges,2.98,7.91,
EZ-IO NEEDLE 45MM,15005114,CDM,489,RC,,,OUTPATIENT,,,392.00,156.80,,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.2,60,,188.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.8,40,,125.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,274.4,70,,219.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,333.2,
FIBERTAK BICEPS IMPLANT SET,15005115,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2456.00,982.40,,,,,,other ,not seperately reimbursable,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1473.6,60,,1178.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,982.4,40,,785.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,2087.6,85,,1670.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,1719.2,70,,1375.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,785.92,32,,628.74,percent of total billed charges,32% of total billed charges,785.92,2087.6,
FIBERTAK BICEPS IMPLANT,15005116,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,2800.00,1120.00,,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,32,,716.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1680,60,,1344,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1120,40,,896,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,2380,85,,1904,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,32,,716.8,percent of total billed charges,32% of total billed charges,1960,70,,1568,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,32,,716.8,percent of total billed charges,32% of total billed charges,896,2380,
TAPERES,15005117,CDM,272,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
EZ-IO NEEDLE 15MM,15005118,CDM,489,RC,,,OUTPATIENT,,,392.15,156.86,,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.29,60,,188.23,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.86,40,,125.49,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,333.33,85,,266.66,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,274.51,70,,219.61,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,32,,100.39,percent of total billed charges,32% of total billed charges,125.49,333.33,
ZO NOT USE NEW#32005135,15005135,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
TIE VEST LRG,15005309,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
TIE VEST MED,15005310,CDM,271,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
TIE VEST XLG,15005311,CDM,272,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
TIE VEST SM,15005312,CDM,271,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
RESTRAINT POSEY,15005317,CDM,271,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SANITARY BELT,15005325,CDM,271,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SURGICAL SCRUB 4 OZ,15005337,CDM,271,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SYRINGE BULB IRRIGATION 2OZ,15005421,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
XERO FORM 5X9 DRESSING,15005422,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
XERO FORM 4X4 DRESSING,15005423,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ZISCONTINUED 010105,15005424,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BAIR HUGGER-HALF,15005425,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
BAIR HUGGER-FULL,15005426,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
BREAST PUMP,15005427,CDM,272,RC,,,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.4,40,,27.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
CATH TROCAR 8FR,15005454,CDM,272,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
CATH TROCAR 10FR,15005455,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
CATH TROCAR 16FR,15005456,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
VAG PACKING,15005457,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE LUMBAR P 25GX1,15005464,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CATH INFUSION PERIP/CENTR/MIDLINE,15005498,CDM,272,RC,C1751,HCPCS,OUTPATIENT,,,154.00,61.60,,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.4,60,,73.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.6,40,,49.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,107.8,70,,86.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,130.9,
WRAP NELLOCAR PEDI/INFANT,15005510,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE SPINAL 18GX6,15005678,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
ROSS J TUBE,15005679,CDM,272,RC,,,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
RESTORE HYDROGEL STL,15005693,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
VENTED CONTINU-FLO SET 3,15005713,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
UNIVERSAL IV SET,15005715,CDM,271,RC,,,OUTPATIENT,,,8.17,3.27,,,,,,other ,not seperately reimbursable,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.9,60,,3.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.27,40,,2.62,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,6.94,85,,5.55,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,5.72,70,,4.58,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,2.61,32,,2.09,percent of total billed charges,32% of total billed charges,2.61,6.94,
SUPPORTER SML,15005738,CDM,271,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
SUPPORTER MEDIUM,15005739,CDM,271,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
SUPPORTER LARGE,15005740,CDM,271,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
TELFA 2X3 EA,15005856,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ICE PACK SECURE ALL,15005873,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
STOMAHESIVE 4 X 4,15005879,CDM,272,RC,,,OUTPATIENT,,,5.75,2.30,,,,,,other ,not seperately reimbursable,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.45,60,,2.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.3,40,,1.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,4.89,85,,3.91,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,4.03,70,,3.22,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,1.84,32,,1.47,percent of total billed charges,32% of total billed charges,1.84,4.89,
SITZ BATH (DISP),15005952,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
UNIVERSAL ABD BINDER MALE/FEMAL 10,15005994,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
ARM SLING LRG,15006034,CDM,271,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ARM SLING MED,15006035,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ARM SLING SMALL,15006036,CDM,271,RC,,,OUTPATIENT,,,5.50,2.20,,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.3,60,,2.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,4.68,85,,3.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,3.85,70,,3.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,4.68,
ARM SLING CHILD,15006037,CDM,271,RC,,,OUTPATIENT,,,5.50,2.20,,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.3,60,,2.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,4.68,85,,3.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,3.85,70,,3.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,4.68,
ARM SLING UNIVERSIAL,15006038,CDM,271,RC,,,OUTPATIENT,,,5.50,2.20,,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.3,60,,2.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,4.68,85,,3.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,3.85,70,,3.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,4.68,
PUNCH BIOPSY 2MM,15006067,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PUNCH BIOPSY 4MM,15006068,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PUNCH BIOPSY 6MM,15006069,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PUNCH BIOPSY 2.5MM,15006070,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CLAVICLE STRAP ADULT DELUXE,15006109,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
CLAVICLE STRAP INFANT DELUXE,15006110,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
CLAVICLE STRAP CHILD DELUXE,15006111,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
CLAVICLE STRAP YOUTH DELUXE,15006112,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CATH TROCAR 20FR,15006144,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
CATH-UMBILICAL VESSEL 3 5 FR,15006151,CDM,272,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18,40,,14.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
CATH URETHERAL 12FR,15006155,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH URETHERAL 20FR,15006156,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH URETERAL 10FR,15006157,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH URETHERAL 14FR,15006158,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH URETHERAL 8FR,15006159,CDM,272,RC,C1758,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH UMBILICAL VESSEL 5 FR,15006169,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14,40,,11.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
MUCUS TRAP 8FR,15006177,CDM,272,RC,,,OUTPATIENT,,,6.85,2.74,,,,,,other ,not seperately reimbursable,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.11,60,,3.29,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,5.82,85,,4.66,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,4.8,70,,3.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,2.19,32,,1.75,percent of total billed charges,32% of total billed charges,2.19,5.82,
FEEDING TUBE 8,15006202,CDM,272,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
BRIEFS WINGS INCONT LRG,15006210,CDM,271,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.6,40,,17.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
CATH SUCT 12F,15006211,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SURGICEL EA 2X3,15006235,CDM,272,RC,,,OUTPATIENT,,,201.00,80.40,,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.6,60,,96.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,80.4,40,,64.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,170.85,
NUGAUZE IODOFORM 1/4,15006236,CDM,272,RC,,,OUTPATIENT,,,5.50,2.20,,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.3,60,,2.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,4.68,85,,3.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,3.85,70,,3.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,32,,1.41,percent of total billed charges,32% of total billed charges,1.76,4.68,
NUGAUZE INDOFORM 1/2,15006244,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
BANDAGE TRIANGULAR PINS 40X56,15006250,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NUGAUZE IODOFORM 1,15006251,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
NUGAUZE IODOFORM 2,15006269,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CATH TROCAR 32FR,15006270,CDM,272,RC,,,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
DRESS TEGADERM 4X4 3/4 (TRANSPARENT),15006276,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ET TUBE CUFFED 3.5MM,15006292,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
INSTRUMENT STERILE SINGLE STRT,15006293,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ET TUBE CUFFED 4.5MM,15006318,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
HUBER NEEDLE 19G,15006320,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
UNIVERSAL RIB BELT 6  MALE,15006323,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
UNIVERSAL RIB BELT 6  FEMALE,15006324,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
UNIVERSAL SLING & SWATHE,15006331,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
WRIST/FOREARM R SML,15006347,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
WRIST FOREARM UNIVERSAL,15006348,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
WRIST/FOREARM VELCRO LXSM,15006350,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
WRIST/FOREARM VELCRO LSML,15006351,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
WRIST/FOREARM UNIVERSAL,15006352,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
WRIST/FOREARM RIGHT MED,15006353,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
WRIST/FOREARM R XSML,15006354,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
KNEE IMMO UNIIVERSAL,15006380,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,112.5,
KNEE IMMO MED,15006381,CDM,272,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
KNEE IMMO 18,15006382,CDM,272,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16,40,,12.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
COVADERM PLUS 6X8,15006395,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SUTURE 1854G,15006428,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
PERIPHERAL INTRAVENOUS CATH SET,15006458,CDM,272,RC,,,OUTPATIENT,,,385.00,154.00,,,,,,other ,not seperately reimbursable,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231,60,,184.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,154,40,,123.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,327.25,85,,261.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,269.5,70,,215.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,123.2,32,,98.56,percent of total billed charges,32% of total billed charges,123.2,327.25,
MIDLINE 20 GAUGE,15006459,CDM,272,RC,,,OUTPATIENT,,,241.00,96.40,,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.6,60,,115.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96.4,40,,77.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,204.85,85,,163.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,168.7,70,,134.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,204.85,
MIDLINE 18 GAUGE,15006460,CDM,272,RC,,,OUTPATIENT,,,241.00,96.40,,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.6,60,,115.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96.4,40,,77.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,204.85,85,,163.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,168.7,70,,134.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,204.85,
INTERLINK CONTINU FLO SOL/MICRO SET,15006467,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
INTERLINK BURETROL SOLN SET-VALVELE,15006483,CDM,272,RC,,,OUTPATIENT,,,19.58,7.83,,,,,,other ,not seperately reimbursable,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.75,60,,9.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.83,40,,6.26,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,16.64,85,,13.31,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,13.71,70,,10.97,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,6.27,32,,5.02,percent of total billed charges,32% of total billed charges,6.27,16.64,
EXTENSION IV SET 33,15006491,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
INTERLINK VENTED SECONDARY MED,15006509,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CARDIOPULMONARY RESUSCITATION,15006512,CDM,489,RC,92950,HCPCS,OUTPATIENT,,,779.00,311.60,,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.4,60,,373.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,418.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,662.15,85,,529.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,545.3,70,,436.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,32,,199.42,percent of total billed charges,32% of total billed charges,249.28,662.15,
TRAY-CVP/HYPER A DRESSING CHANGE TPN,15006532,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
DERMABOND,15006539,CDM,272,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
DERMABOND PROPEN,15006540,CDM,272,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.4,40,,16.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
PCA IV PUMP SET,15006541,CDM,272,RC,,,OUTPATIENT,,,31.00,12.40,,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.6,60,,14.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,26.35,
DUODERM HYD GEL 15GM,15006565,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
IV FILT 22MICRON,15006566,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
TRAY LUMBAR PUCTURE/EAR IRRIGATION PROCE,15006573,CDM,272,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
STRAIGHT BLOOD SET,15006580,CDM,272,RC,,,OUTPATIENT,,,16.50,6.60,,,,,,other ,not seperately reimbursable,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.9,60,,7.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.6,40,,5.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,14.03,85,,11.22,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,11.55,70,,9.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,5.28,32,,4.22,percent of total billed charges,32% of total billed charges,5.28,14.03,
PLATELET FILTER,15006581,CDM,272,RC,,,OUTPATIENT,,,17.22,6.89,,,,,,other ,not seperately reimbursable,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.33,60,,8.26,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.89,40,,5.51,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,14.64,85,,11.71,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,12.05,70,,9.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,5.51,32,,4.41,percent of total billed charges,32% of total billed charges,5.51,14.64,
DRESSING IV TRANS  SITE,15006582,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TRAY FRENCH CATHETER URETH W/BAG,15006607,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
SHOE CAST(BOOT)SM,15006701,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SHOE CAST(BOOT)LRG,15006702,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SHOE CAST(BOOT)MED,15006703,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
NUGAUZE PLAIN 1/4,15006707,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
STERI-STRIP CLOSURE 1/4X1 1/2,15006709,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STERI-STRIP CLOSURE 1/4X3,15006710,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE INTRAOSS 18GA ADG LGTH,15006712,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
KITS ATS TRAUMA,15006778,CDM,272,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,62.8,40,,50.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
PAD EGGCRATE 2  33X72,15006828,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
TRAY MINOR PROCEDURE,15007001,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
TRAY FOLEY 18FR,15007073,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
PATROL PUMP SET W/PIERCING PIN,15007090,CDM,272,RC,,,OUTPATIENT,,,7.50,3.00,,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.5,60,,3.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3,40,,2.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,6.38,85,,5.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,5.25,70,,4.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,6.38,
SET ROSS FEEDING TUBE,15007093,CDM,272,RC,,,OUTPATIENT,,,8.50,3.40,,,,,,other ,not seperately reimbursable,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.1,60,,4.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.4,40,,2.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,7.23,85,,5.78,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,5.95,70,,4.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,2.72,32,,2.18,percent of total billed charges,32% of total billed charges,2.72,7.23,
TUBE SALEM SUMP 10FR,15007109,CDM,272,RC,,,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,62.05,
SCALPEL 10 STER,15007121,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SCALPEL #11 STER,15007122,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SCALPEL 12 STER,15007123,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SCALPEL #20 STER,15007124,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE 1824H,15007126,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
BLOOD TRANSFUSION/ADM,15007127,CDM,391,RC,36430,HCPCS,OUTPATIENT,,,842.00,336.80,,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,505.2,60,,404.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,589.4,70,,471.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,269.44,32,,215.55,percent of total billed charges,32% of total billed charges,46.33,715.7,
TUBE SALEM SUMP 14FR,15007129,CDM,272,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
TRAY-INCISION & DRAINAGE WOUND CLOS,15007131,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TRAY-IRRIGATION W/PISTON SYRINGE,15007149,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
KIT SUTURE REMOVAL,15007255,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TRAY-THORACENTESIS,15007271,CDM,272,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
STOPCOCK-3WAY,15007290,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SHILEY TRACH TUBE 0,15007303,CDM,272,RC,,,OUTPATIENT,,,247.00,98.80,,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.2,60,,118.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,98.8,40,,79.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,172.9,70,,138.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,32,,63.23,percent of total billed charges,32% of total billed charges,79.04,209.95,
SHILEY 5.0,15007304,CDM,272,RC,,,OUTPATIENT,,,92.00,36.80,,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,60,,44.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,64.4,70,,51.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,78.2,
SHILEY 8LPC,15007305,CDM,272,RC,,,OUTPATIENT,,,546.00,218.40,,,,,,other ,not seperately reimbursable,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.6,60,,262.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,464.1,85,,371.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,382.2,70,,305.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,174.72,32,,139.78,percent of total billed charges,32% of total billed charges,174.72,464.1,
SHILEY 6LPC,15007306,CDM,272,RC,,,OUTPATIENT,,,298.00,119.20,,,,,,other ,not seperately reimbursable,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.8,60,,143.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.2,40,,95.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,253.3,85,,202.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,208.6,70,,166.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,95.36,32,,76.29,percent of total billed charges,32% of total billed charges,95.36,253.3,
SHILEY 7SCT,15007307,CDM,272,RC,,,OUTPATIENT,,,152.00,60.80,,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,60,,72.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,60.8,40,,48.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,106.4,70,,85.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,129.2,
SHILEY 10LPC,15007308,CDM,272,RC,,,OUTPATIENT,,,600.00,240.00,,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,60,,288,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240,40,,192,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,420,70,,336,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,510,
CASTING SPLINT 3,15007309,CDM,271,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
CASTING SPLINT 2,15007310,CDM,271,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
KIT TRACH CARE BASIC,15007313,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
CASTING SPLINT 5,15007317,CDM,271,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
"CANISTER, LINER",15007348,CDM,271,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
URETHAL FOLLOWER 20 FR,15007349,CDM,272,RC,,,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
FLEXISHIELD,15007351,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14,40,,11.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
FINGER BASEBALL SPLINT LRG,15007358,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FINGER BASEBALL SPLINT MED0,15007359,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FINGER BASEBALL SPLINT SML,15007360,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SUTURE 1696G,15007381,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
CATHETER -EID,15007382,CDM,272,RC,,,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42,40,,33.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
TRAY FOLEY 16FR,15007388,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
BUTTERFLY 23 GA W/TUBING,15007446,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TRAY-LUMBAR PUNCTURE 21G-2 1/2,15007461,CDM,272,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.8,40,,23.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
TRAY-LUMBAR 18G-3 1/2,15007487,CDM,272,RC,,,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
TRAY-LUMBAR PUNCTURE 22G-1 1/2,15007495,CDM,272,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.8,40,,23.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MULTI-DEX DRESSING,15007520,CDM,272,RC,,,OUTPATIENT,,,31.00,12.40,,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.6,60,,14.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,26.35,
URINE COLLECTOR PEDIATRIC,15007688,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
U-BAG REG NEWBORN,15007712,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
URINE 24 HR COLLECTOR PEDIATRI,15007738,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NIPPLE SHIELD   #17516,15007754,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
BILI MASK,15007756,CDM,271,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
VAGINAL SPECULUM DISP LRG,15007862,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
VAGINAL SPECULUM DISP MED,15007863,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
VAGINAL SPECULUM DISP SML,15007864,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MONITOR-TELEMETRY DAILY,15008139,CDM,272,RC,,,OUTPATIENT,,,316.00,126.40,,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.6,60,,151.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,268.6,
K-PADS DISP DURATHERM EACH,15008147,CDM,272,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18,40,,14.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
TUBE CONN N/COND 1/4X10ST,15008451,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
ENDOTRACHEAL TUBE INTRODUCER,15008452,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
POUCH POUCH 2 1/4,15008766,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
WAFER SURFIT 2 3/4,15008774,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SHOE SURG WOMAN LRG,15008800,CDM,271,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SHOE SURG WOMAN SML,15008801,CDM,271,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SHOE SURG WOMAN MED,15008802,CDM,271,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SHOE SURG CHILD,15008803,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SHOE SURG MEN MED,15008805,CDM,271,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SHOE SURG MEN LRG,15008806,CDM,271,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
ANCHOR/SCREW BOBE TO BONE TISS TO BONE,15008807,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1440.00,576.00,,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,864,60,,691.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,576,40,,460.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,1224,85,,979.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,1008,70,,806.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,1224,
SURFIT POUCH 1 1/2,15008873,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MITTENS,15008935,CDM,272,RC,,,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.4,40,,27.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
WOUND DRAINAGE (HOLLISTER ) SM EA,15009031,CDM,272,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
BLANKETROL DISP BLANKET PED,15009072,CDM,272,RC,,,OUTPATIENT,,,115.00,46.00,,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46,40,,36.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,97.75,
CATH 3WAY 18FR,15009098,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
HUBER NEEDLE 22G,15009106,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
IRRIGATION SET,15009122,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SPONGE DRAIN,15009135,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
POUCH SURFIT 4,15009138,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
WAFER SURFIT 1 1/4,15009139,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SET IV SPECIAL,15009140,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
CATH INFUSION PERIP/CENTR/MIDLINE,15009148,CDM,272,RC,C1751,HCPCS,OUTPATIENT,,,316.00,126.40,,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.6,60,,151.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,268.6,
CATHER URETHRAL PHILLIPS,15009163,CDM,272,RC,,,OUTPATIENT,,,301.00,120.40,,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.6,60,,144.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.4,40,,96.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,255.85,85,,204.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,210.7,70,,168.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,32,,77.06,percent of total billed charges,32% of total billed charges,96.32,255.85,
DRESSING CURASORB,15009164,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PERCUTANEOUS SHEATH INTRO 8 5A,15009171,CDM,272,RC,,,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.6,40,,28.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,75.65,
SPLINTS PRIMACAST 3X12,15009176,CDM,271,RC,,,OUTPATIENT,,,8.42,3.37,,,,,,other ,not seperately reimbursable,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.05,60,,4.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.37,40,,2.7,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,7.16,85,,5.73,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,5.89,70,,4.71,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,2.69,32,,2.15,percent of total billed charges,32% of total billed charges,2.69,7.16,
SPLINTS PRIMACAST 3X35,15009177,CDM,271,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SPLINTS PRIMACAST 4X30,15009178,CDM,271,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
SPLINTS PRIMACAST 4X15,15009179,CDM,271,RC,,,OUTPATIENT,,,12.43,4.97,,,,,,other ,not seperately reimbursable,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.46,60,,5.97,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.97,40,,3.98,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,10.57,85,,8.46,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,8.7,70,,6.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,3.98,32,,3.18,percent of total billed charges,32% of total billed charges,3.98,10.57,
SPLINTS PRIMACAST 5X30,15009181,CDM,271,RC,,,OUTPATIENT,,,20.65,8.26,,,,,,other ,not seperately reimbursable,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.39,60,,9.91,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.26,40,,6.61,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,17.55,85,,14.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,14.46,70,,11.57,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,6.61,32,,5.29,percent of total billed charges,32% of total billed charges,6.61,17.55,
TRACH HOLDER,15009218,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CATH INFUSION PERIP/CENTR/MIDLINE,15009247,CDM,272,RC,C1751,HCPCS,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,119,
CHEST TUBE 12FR,15009296,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14,40,,11.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
LEG BAG EXTENSION TUBING,15009312,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CATH SHEATH ADAPTER,15009320,CDM,272,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
SUTURE 698G,15009346,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
HUBER NEEDLE 20G,15009353,CDM,272,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
ANKLE BRACE-LEFT STANDARD(ANK STIRRUP),15009395,CDM,272,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
AIR SPLINT UNIVERSAL,15009397,CDM,274,RC,L4350,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
THUMB BRACE,15009398,CDM,274,RC,L3923,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
COBAN 6  STER,15009399,CDM,271,RC,A6455,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
TUBE GASTROSCOPY 20FR,15009429,CDM,272,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
BLANKET PAD 3276,15009552,CDM,272,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
HIP ARTHROPLASTY KIT W/BLADE,15009868,CDM,272,RC,,,OUTPATIENT,,,1474.00,589.60,,,,,,other ,not seperately reimbursable,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,884.4,60,,707.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,1252.9,85,,1002.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,1031.8,70,,825.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,471.68,32,,377.34,percent of total billed charges,32% of total billed charges,471.68,1252.9,
TAPE CAST 1,15009890,CDM,271,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PADS DEFIBRILATOR GEL 4.5X4.5,15009962,CDM,271,RC,,,OUTPATIENT,,,10.70,4.28,,,,,,other ,not seperately reimbursable,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.42,60,,5.14,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,9.1,85,,7.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,7.49,70,,5.99,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,3.42,32,,2.74,percent of total billed charges,32% of total billed charges,3.42,9.1,
SCALPEL 15 STER,15009979,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ATS BAG REPLACE PLEUR-EVAC,15009996,CDM,272,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
GUIDE WIRE TROCAR TIP (AR-8943-01),15009997,CDM,272,RC,C1769,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
FIBERLINK (AR-7535),15009998,CDM,272,RC,,,OUTPATIENT,,,234.00,93.60,,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.4,60,,112.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,163.8,70,,131.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,32,,59.9,percent of total billed charges,32% of total billed charges,74.88,198.9,
US BIO THYROID PERCUTANEOUS CORE NEEDLE,15060100,CDM,402,RC,60100,HCPCS,OUTPATIENT,,,723.00,289.20,,,,,,other ,not seperately reimbursable,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.8,60,,347.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,138.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,614.55,85,,491.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,506.1,70,,404.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,231.36,32,,185.09,percent of total billed charges,32% of total billed charges,138.73,614.55,
IV Hydration Init 31 min to 1 hr,15096360,CDM,761,RC,96360,HCPCS,OUTPATIENT,,,415.00,166.00,,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249,60,,199.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,290.5,70,,232.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,41.9,352.75,
IV Hydration Addl Hr,15096361,CDM,761,RC,96361,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,15.88,51.85,
INFUSION IV THERAPY-1ST HR,15096365,CDM,262,RC,96365,HCPCS,OUTPATIENT,,,195.00,78.00,,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117,60,,93.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,165.75,
INFUSION IV THERAPY-EA ADD'L HR,15096366,CDM,262,RC,96366,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
IV INFUSION THERAPY SEQ UP TO I HR,15096367,CDM,260,RC,96367,HCPCS,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
IV INFUSION THERAPY CONCURRENT,15096368,CDM,760,RC,96368,HCPCS,OUTPATIENT,,,61.00,24.40,,1500,100,,,case rate,pays based on per visit rate,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,1500,
"INJECTION, IM OR SUBQ THERAPEUTIC",15096372,CDM,260,RC,96372,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,17.71,62.9,
ED INJ INTRA-ARTERIAL,15096373,CDM,760,RC,96372,HCPCS,OUTPATIENT,,,58.00,23.20,,1500,100,,,case rate,pays based on per visit rate,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,17.71,1500,
IVP SINGLE OR INITIAL SUBSTANCE/DRUG,15096374,CDM,940,RC,96374,HCPCS,OUTPATIENT,,,429.00,171.60,,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.4,60,,205.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,300.3,70,,240.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,137.28,32,,109.82,percent of total billed charges,32% of total billed charges,48.01,364.65,
IVP EA ADDL SEQ  NEW  SUBSTANCE/DRUG,15096375,CDM,940,RC,96375,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,19.56,70.55,
IVP EA ADDL SEQ  SAME  SUBSTANCE/DRUG,15096376,CDM,940,RC,96376,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
"EOSINOPHIL COUNT,ABSOLUTE COUNT(BLOOD)",17005488,CDM,305,RC,85048,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,9.82,272,,,fee schedule,272% of BCBS fee schedule,9.82,272,,,fee schedule,272% of BCBS fee schedule,9.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.17,10.2,
RAST CHILD'S FOOD ALLERGY,17006321,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,351.00,140.40,,4.83,100,,,fee schedule,100% of Aetna fee schedule,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,210.6,60,,168.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,245.7,70,,196.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,4.83,298.35,
ERYTHROPOIETIN,17006589,CDM,301,RC,82668,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.57,272,,,fee schedule,272% of BCBS fee schedule,72.57,272,,,fee schedule,272% of BCBS fee schedule,72.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,23.48,72.57,
C DIFFICULE TOX B QUALITAVE BY PCR,17016377,CDM,306,RC,87493,HCPCS,OUTPATIENT,,,123.00,49.20,,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.8,60,,59.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,104.55,
PROLACTIN DILUTION STUDY,17040049,CDM,301,RC,84146,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,74.8,
VALPROIC ACID FREE,17080165,CDM,301,RC,80165,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,16.92,53.55,
INTERLEUKIN 28B POLYMORPHISMS,17081479,CDM,310,RC,81283,HCPCS,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,91.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
FACTOR IX ACTIVITY & HUMAN INHIBITOR,17085335,CDM,305,RC,85335,HCPCS,OUTPATIENT,,,278.00,111.20,,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,49.72,272,,,fee schedule,272% of BCBS fee schedule,49.72,272,,,fee schedule,272% of BCBS fee schedule,49.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,166.8,60,,133.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,194.6,70,,155.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,16.08,236.3,
ISLET CELL ANTIBODY,17110584,CDM,302,RC,86341,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,29.46,93.5,
LIPO FRACTION & QUANT (ULTRA),17136435,CDM,301,RC,83701,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,46.54,
COXSACKIE A PANEL #2,17307392,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
ANAERABE E-TEST PROFILE #3,17387183,CDM,306,RC,87181,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HEP B VIRAL DNA QUANTITATIVE,17600001,CDM,306,RC,87517,HCPCS,OUTPATIENT,,,479.00,191.60,,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.4,60,,229.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,407.15,85,,325.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,335.3,70,,268.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,53.55,407.15,
HANSEL STAIN   GENERIC,17600002,CDM,306,RC,89190,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.23,19.55,
HOMOVANILLIC ACID RANDOM URINE,17600003,CDM,301,RC,83150,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
"VMA, RANDOM URINE",17600004,CDM,301,RC,84585,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.84,272,,,fee schedule,272% of BCBS fee schedule,59.84,272,,,fee schedule,272% of BCBS fee schedule,59.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.37,59.84,
BF ALBUMIN  (BODY FLUID),17600005,CDM,301,RC,82042,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
RAST CRAB  IGE,17600006,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST SHRIMP IGE,17600007,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
PARVOVIRUS B-19 IgG,17600009,CDM,302,RC,86747,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.02,272,,,fee schedule,272% of BCBS fee schedule,58.02,272,,,fee schedule,272% of BCBS fee schedule,58.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.78,58.02,
PARVOVIRUS B-19 IgM,17600010,CDM,302,RC,86747,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.02,272,,,fee schedule,272% of BCBS fee schedule,58.02,272,,,fee schedule,272% of BCBS fee schedule,58.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.78,58.02,
ENZYMATIC DIGESTION,17600011,CDM,301,RC,83892,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
"FECAL FAT, QUALITATIVE",17600012,CDM,301,RC,82705,HCPCS,OUTPATIENT,,,166.00,66.40,,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,19.67,272,,,fee schedule,272% of BCBS fee schedule,19.67,272,,,fee schedule,272% of BCBS fee schedule,19.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,6.37,141.1,
SEPERATION BY GEL ELECTRULORESIS,17600013,CDM,301,RC,83894,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
AMPLIFICATION OF PAT. NUCLEAR ACID,17600014,CDM,301,RC,83898,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
CULTURE ACID FAST CONCENTRATION,17600015,CDM,306,RC,87015,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,8.35,27.2,
INTERPRETATION  & REPORT,17600016,CDM,310,RC,83912,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CLOSTRIDIUM DIFF CULTURE,17600018,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,8.28,27.2,
HEP C RNA QUAL W/GENOTYPE LIPA REFLEX,17600021,CDM,306,RC,87902,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,321.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,321.81,
THYROTROPIN RECEPTOR AB(TBII),17600022,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,21.58,80.75,
ACID FAST STAIN,17600023,CDM,306,RC,87206,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,6.73,21.25,
"TISSUE(IgG,IgA)TRANSGLUTAMINASE ANTIBODI",17600024,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,14.41,46.75,
ANTIENDOMYSIAL ANTIBODIES GENERIC,17600025,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
EOSINOPHIL URINE (HANSEL STAIN),17600026,CDM,306,RC,89190,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.23,19.55,
ASPERGILLUS NIGER,17600027,CDM,302,RC,86606,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.81,58.1,
ASPERGILLUS FLAVUS,17600028,CDM,302,RC,86606,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.81,58.1,
ASPERGILLUS FUMIGATUS,17600029,CDM,302,RC,86606,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.81,58.1,
.TRYPSIN(SERUM),17600031,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
THYROID PEROXIDASE ANTIBODY (TPO),17600032,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,18.18,56.17,
RAST CORN IgE,17600033,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
"RAST WHEAT, IgE",17600034,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
BF BILIRUBIN (BODY FLUID),17600035,CDM,301,RC,82247,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,18.88,
RAST BAKERS YEAST IgE,17600036,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST COCOA(CHOCOLATE) IgE,17600037,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
IGF BINDING PROTEIN-3,17600038,CDM,301,RC,82397,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,17.65,80.75,
RAST EGG WHITES IgE,17600039,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
SLEEVE THIGH REGULAR,17600040,CDM,271,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
Q FEVER IGG-PHASE I,17600042,CDM,302,RC,86638,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.15,46.81,
"HBV AG DNA, QUAL REALTIME PCR",17600043,CDM,306,RC,87516,HCPCS,OUTPATIENT,,,226.00,90.40,,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.6,60,,108.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,43.86,192.1,
RAST MILK IgEE,17600044,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
IGE ALLERGY TOTAL,17600045,CDM,301,RC,86003,HCPCS,OUTPATIENT,,,75.00,30.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,4.83,63.75,
"SUBSTITUTIONS, PLASMA FRACTIONS#2",17600047,CDM,305,RC,85732,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,8.08,25,
"SUBSTITUTIONS, PLASMA FRACTIONS#1",17600048,CDM,305,RC,85732,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,8.08,25,
IMMUNOFIXATION(SERUM),17600049,CDM,302,RC,86334,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,86.25,272,,,fee schedule,272% of BCBS fee schedule,86.25,272,,,fee schedule,272% of BCBS fee schedule,86.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,27.92,86.25,
Q FEVER IGG-PHASE II,17600050,CDM,302,RC,86638,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.15,46.81,
Q FEVER IgM-PHASE I,17600051,CDM,302,RC,86638,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.15,46.81,
Q FEVER IgM-PHASE II,17600052,CDM,302,RC,86638,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,46.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.15,46.81,
.CD4 ABSOLUTE COUNT,17600053,CDM,302,RC,86361,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,33.47,
RAST LATEX (IGE RAST ALLERGY),17600054,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
TULAREMIA ANTIBODY,17600055,CDM,302,RC,86668,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.17,272,,,fee schedule,272% of BCBS fee schedule,40.17,272,,,fee schedule,272% of BCBS fee schedule,40.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
LYMPHOGRANULOMA (LGV) ANTIBODY,17600056,CDM,302,RC,86631,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.77,45.9,
CMV AB IGG (CYTOMEGALOVIRUS),17600057,CDM,302,RC,86644,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,17.98,56.1,
"HIV RNA, QUANTITATIVE PCR, 2ND GENERATIO",17600058,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
PARAINFLUENZA V. AG DETECTION,17600059,CDM,306,RC,87279,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
PARAINFLUENZA 1,17600060,CDM,306,RC,87279,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
PARAINFLUENZA 2,17600061,CDM,306,RC,87279,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
PARAINFLUENZA 3,17600062,CDM,306,RC,87279,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
MAGNESIUM 24 HOUR URINE,17600063,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,52.00,20.80,,6.2,100,,,fee schedule,100% of Aetna fee schedule,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,25.87,272,,,fee schedule,272% of BCBS fee schedule,25.87,272,,,fee schedule,272% of BCBS fee schedule,25.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,6.2,44.2,
CULTURE BLOOD,17600064,CDM,306,RC,87040,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,12.9,60.35,
"MELATONIN, PLASMA",17600065,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,21.58,80.75,
URIC ACID-24 HOUR,17600066,CDM,301,RC,84560,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.35,19.55,
**CYSTIC FIBROS DNA PROBE ANALYSIS#1,17600067,CDM,301,RC,83901,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
CYSTIC FIBROSIS DNA ANALYSIS,17600068,CDM,310,RC,81221,HCPCS,OUTPATIENT,,,315.00,126.00,,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,60,,151.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,267.75,
DOT/SLOT BLOT PRODUCTION,17600069,CDM,301,RC,83893,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
"NUCLEIC ACID PROBE, EACH(1-27)",17600070,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
T3 FREE,17600071,CDM,301,RC,84481,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,59.11,272,,,fee schedule,272% of BCBS fee schedule,59.11,272,,,fee schedule,272% of BCBS fee schedule,59.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,21.17,60.35,
CULTURE ROUTINE,17600072,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
TRYPTASE,17600073,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.99,
GLUCOSE TOL-1 ADD'L SPECIMEN,17600075,CDM,301,RC,82952,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,12.97,272,,,fee schedule,272% of BCBS fee schedule,12.97,272,,,fee schedule,272% of BCBS fee schedule,12.97,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,4.9,17,
GLUCOSE TOL-3 SPECIMENS,17600076,CDM,301,RC,82951,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,16.08,55.25,
"FAT, URINE OR FLUIDS",17600077,CDM,301,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
HIV-1 RNA QUANTITATIVE 3RD GENERATION,17600078,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
HIV-I RNA QUANTITTATIVE PCR EXPANDED RNG,17600079,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
THYROID STIMULATING IMMUNOGLOBULIN(TSI),17600080,CDM,301,RC,84445,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,63.57,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
RAST STRAWBERRY IGE,17600081,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST CEPHALOSPORIUM ACREMODIUM IGE,17600082,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST PENICILLOYL  G(C1) IGE,17600083,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
11-DEOXYCORTISOL (COMPOUND S) 24UA,17600084,CDM,301,RC,82634,HCPCS,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,113.02,272,,,fee schedule,272% of BCBS fee schedule,113.02,272,,,fee schedule,272% of BCBS fee schedule,113.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,36.6,113.02,
LEAD(INDUSTRIAL),17600085,CDM,301,RC,83655,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,15.13,72.25,
GLYCOHEMOGLOBIN(REFERENCE),17600086,CDM,301,RC,83036,HCPCS,OUTPATIENT,,,54.00,21.60,,8.99,100,,,fee schedule,100% of Aetna fee schedule,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.48,272,,,fee schedule,272% of BCBS fee schedule,37.48,272,,,fee schedule,272% of BCBS fee schedule,37.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,8.99,45.9,
VITAMIN B2,17600087,CDM,301,RC,84252,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
VITAMIN B1,17600088,CDM,301,RC,84425,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,32.88,272,,,fee schedule,272% of BCBS fee schedule,32.88,272,,,fee schedule,272% of BCBS fee schedule,32.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
RAST PENICILLIN V,17600089,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST AMOXICILLIN,17600090,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
NUCLEAR MAGNETIC RESONNANCING LIPOPROFIL,17600091,CDM,301,RC,83701,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
CHOLINESTERASE SERUM,17600092,CDM,301,RC,82480,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,26.71,272,,,fee schedule,272% of BCBS fee schedule,26.71,272,,,fee schedule,272% of BCBS fee schedule,26.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,9.83,28.9,
DOT/SLOT BLOT PRODUCTION,17600093,CDM,301,RC,83893,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SEPARATION BY GEL ELECTROPHORESIS,17600094,CDM,302,RC,83894,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
"NUCLEIC ACID PROBE, EACH",17600095,CDM,302,RC,83896,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
"AMPLIF OD PAT NUCLEIC ACID,MUTIPLER EACH",17600096,CDM,302,RC,83901,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
ISOLAT OR EXTRAC OF HIGHLY PRUIFD NUC AC,17600097,CDM,302,RC,83891,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
HEMOCHROMOTOSIS DNA MUTATION,17600098,CDM,310,RC,81256,HCPCS,OUTPATIENT,,,542.00,216.80,,,,,,other ,not seperately reimbursable,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.2,60,,260.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,379.4,70,,303.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,173.44,32,,138.75,percent of total billed charges,32% of total billed charges,81.7,460.7,
IgG SUBCLASS IgG 4,17600099,CDM,301,RC,82787,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,46.84,
PROTEIN URINE QUANTITATIVE-RANDOM,17600101,CDM,301,RC,84156,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,4.58,16.15,
ANTI-SMOOTH MUSCLE ANTIBODY (ACTIN AB),17600103,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
ACETYLCHOLINE RECEPTOR MODULATING ANTIBO,17600104,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,232.00,92.80,,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,139.2,60,,111.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,162.4,70,,129.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,23,197.2,
ZINC PROTOPORPHYRINE,17600105,CDM,301,RC,84202,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,28.7,272,,,fee schedule,272% of BCBS fee schedule,28.7,272,,,fee schedule,272% of BCBS fee schedule,28.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
CULTURE FUNGUS,17600106,CDM,306,RC,87102,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,32.42,272,,,fee schedule,272% of BCBS fee schedule,32.42,272,,,fee schedule,272% of BCBS fee schedule,32.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,10.51,35.7,
BARIUM,17600107,CDM,301,RC,83018,HCPCS,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,27.45,84.78,
RAST LEMON (F208),17600108,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST ORANGE (F33),17600109,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
TRANXENE(CLORAZEPATE),17600110,CDM,301,RC,80306,HCPCS,OUTPATIENT,,,84.00,33.60,,13.47,100,,,fee schedule,100% of Aetna fee schedule,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,13.47,71.4,
RAST APPLE IGE (F49),17600111,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST BEEF Ige (F27),17600112,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST CHICKEN MEAT Ige (F83),17600113,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
****GC SCREEN,17600114,CDM,306,RC,87590,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
BUN(BODY FLUIDS),17600115,CDM,301,RC,84520,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,15.23,272,,,fee schedule,272% of BCBS fee schedule,15.23,272,,,fee schedule,272% of BCBS fee schedule,15.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,4.93,22.95,
RAST PORK Ige (F26),17600116,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
INHIBIN A,17600118,CDM,302,RC,86336,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,19.48,54.4,
ADENOVIRUS SCREEN AG,17600119,CDM,306,RC,87301,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,14.97,46.75,
CREATININE(BODY FLUIDS),17600120,CDM,301,RC,82570,HCPCS,OUTPATIENT,,,22.00,8.80,,4.79,100,,,fee schedule,100% of Aetna fee schedule,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.79,19.96,
RAST CHEESE,17600121,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
"CHLAMYDIA,RNA TMA",17600122,CDM,306,RC,87491,HCPCS,OUTPATIENT,,,122.00,48.80,,32.5,100,,,fee schedule,100% of Aetna fee schedule,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,32.5,103.7,
RAST SCALLOPS,17600123,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
ISOLATION OF HIGHTLY PURIFIED NUC ACID,17600124,CDM,302,RC,83891,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
"AMPLIFICATION OF PT NU ACD, MULTIPLEX,EA",17600125,CDM,302,RC,83901,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
LYMPHOCYTE SUBSET PANEL 5,17600126,CDM,302,RC,86361,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,33.47,
PSA FREE & TOTAL,17600127,CDM,301,RC,84154,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,69.14,272,,,fee schedule,272% of BCBS fee schedule,69.14,272,,,fee schedule,272% of BCBS fee schedule,69.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,22.98,70.55,
"PHOSPHORUS, 24 HR URINE",17600128,CDM,301,RC,84105,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,17.49,272,,,fee schedule,272% of BCBS fee schedule,17.49,272,,,fee schedule,272% of BCBS fee schedule,17.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.22,19.55,
DRUG SCREEN SERUM CHAIN OF CUSTODY 10 PL,17600129,CDM,301,RC,99000,HCPCS,OUTPATIENT,,,375.00,150.00,,,,,,other ,not seperately reimbursable,120,32,,96,percent of total billed charges,32% of total billed charges,120,32,,96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225,60,,180,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,32,,96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,32,,96,percent of total billed charges,32% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,32,,96,percent of total billed charges,32% of total billed charges,120,32,,96,percent of total billed charges,32% of total billed charges,262.5,70,,210,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120,32,,96,percent of total billed charges,32% of total billed charges,120,32,,96,percent of total billed charges,32% of total billed charges,120,318.75,
IMMUNOASSAY,17600130,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
GAS CHROMATOGRAPHY/FID,17600131,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
GAS CHROMATOGRAPHY/ECD,17600132,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
GAS CHROMATOGRAPHY/MS,17600133,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
THYROTROPIN (TBII)BINDING INHIBITORY IGG,17600135,CDM,301,RC,84235,HCPCS,OUTPATIENT,,,235.00,94.00,,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,202.01,272,,,fee schedule,272% of BCBS fee schedule,202.01,272,,,fee schedule,272% of BCBS fee schedule,202.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,141,60,,112.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,164.5,70,,131.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,202.01,
THYROGLOBULIN AB,17600137,CDM,302,RC,86800,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.39,272,,,fee schedule,272% of BCBS fee schedule,61.39,272,,,fee schedule,272% of BCBS fee schedule,61.39,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,19.88,61.39,
MICROSOMAL ANTIBODY(THYROID OR LVR-KDNY),17600138,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,18.18,56.17,
HEP C RNA PCR(VIRAL LOAD) QUANT W/REFLEX,17600139,CDM,306,RC,87522,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,53.55,163.2,
***HEP C QUANTIFICATION,17600140,CDM,306,RC,87522,HCPCS,OUTPATIENT,,,351.00,140.40,,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.6,60,,168.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,245.7,70,,196.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,112.32,32,,89.86,percent of total billed charges,32% of total billed charges,53.55,298.35,
LIPOPROTEIN(a),17600141,CDM,301,RC,83700,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,43.47,272,,,fee schedule,272% of BCBS fee schedule,43.47,272,,,fee schedule,272% of BCBS fee schedule,43.47,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,14.07,55.25,
INHIBITOR # 1-PT MIX STUDY,17600143,CDM,305,RC,85610,HCPCS,OUTPATIENT,,,20.00,8.00,,3.64,100,,,fee schedule,100% of Aetna fee schedule,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,3.64,17,
INHIBITOR # 2-PT MIX STUDY,17600144,CDM,305,RC,85610,HCPCS,OUTPATIENT,,,20.00,8.00,,3.64,100,,,fee schedule,100% of Aetna fee schedule,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,3.64,17,
INHIBITOR # 3-PT MIX STUDY,17600145,CDM,305,RC,85610,HCPCS,OUTPATIENT,,,20.00,8.00,,3.64,100,,,fee schedule,100% of Aetna fee schedule,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,3.64,17,
GRAM STAIN,17600148,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,30.10,12.04,,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18.06,60,,14.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,25.59,85,,20.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,21.07,70,,16.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,5.33,25.59,
FACTOR V LEIDEN,17600149,CDM,310,RC,81241,HCPCS,OUTPATIENT,,,577.00,230.80,,,,,,other ,not seperately reimbursable,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.2,60,,276.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,91.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,490.45,85,,392.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,403.9,70,,323.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,184.64,32,,147.71,percent of total billed charges,32% of total billed charges,91.71,490.45,
POTASSIUM(FECES),17600150,CDM,301,RC,84999,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
VIP LEVEL(VASPACTIVE INHIBITORY PEPTID),17600151,CDM,301,RC,84586,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,72.13,272,,,fee schedule,272% of BCBS fee schedule,72.13,272,,,fee schedule,272% of BCBS fee schedule,72.13,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
SODIUM(FECES),17600152,CDM,301,RC,84302,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,6.07,28.9,
FUNGAL PREP (KOH),17600155,CDM,306,RC,87220,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
ANCA(ANTI-NEUTROPHIL CYTOPLASMIC ANTI),17600156,CDM,302,RC,86021,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.81,57.8,
.PRO BRAIN NATRIURETIC PEPTIDE,17600157,CDM,301,RC,83880,HCPCS,OUTPATIENT,,,152.00,60.80,,31.43,100,,,fee schedule,100% of Aetna fee schedule,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,60,,72.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,49.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,106.4,70,,85.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,31.43,129.2,
"PLATELET AB, Indirect(IgG)",17600158,CDM,302,RC,86022,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,70.91,272,,,fee schedule,272% of BCBS fee schedule,70.91,272,,,fee schedule,272% of BCBS fee schedule,70.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,22.96,70.91,
C 1 ESTERASE,17600159,CDM,302,RC,86161,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15,46.75,
OCCULT BLOOD (STOOL) OUTPATIENT DX,17600160,CDM,301,RC,82272,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.28,14.45,
IMMUNOASSAY#1,17600162,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
FECAL BLOOD (FOBT) SCREEN,17600163,CDM,301,RC,82270,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,9.76,272,,,fee schedule,272% of BCBS fee schedule,9.76,272,,,fee schedule,272% of BCBS fee schedule,9.76,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
IMMUNOASSAY#2,17600164,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
CELIAC DISEASE AB PANEL,17600165,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,403.00,161.20,,,,,,other ,not seperately reimbursable,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,241.8,60,,193.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,342.55,85,,274.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,282.1,70,,225.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,128.96,32,,103.17,percent of total billed charges,32% of total billed charges,21.58,342.55,
IMMUNOGLOBULIN,17600166,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,42.00,16.80,,8.61,100,,,fee schedule,100% of Aetna fee schedule,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,8.61,35.9,
HERPES 1 IgG HERPES SELECT,17600168,CDM,302,RC,86695,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.48,51,
GLUTEN ANTIBODY (IGE),17600169,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
HERPES 2 IgG  HERPES SELECT,17600170,CDM,302,RC,86696,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,24.18,73.95,
O & P (OVA & PARASITES),17600171,CDM,306,RC,87177,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.35,272,,,fee schedule,272% of BCBS fee schedule,34.35,272,,,fee schedule,272% of BCBS fee schedule,34.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,11.12,34.85,
LDL SUBPARTICLES,17600172,CDM,301,RC,82664,HCPCS,OUTPATIENT,,,154.00,61.60,,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,132.63,272,,,fee schedule,272% of BCBS fee schedule,132.63,272,,,fee schedule,272% of BCBS fee schedule,132.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,92.4,60,,73.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,76.87,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,107.8,70,,86.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,132.63,
..OXCARBAZEPINE(TRILEPTAL),17600175,CDM,301,RC,80183,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,16.56,67.15,
"HERPES 1&2, AMNIOTIC FLUID",17600176,CDM,306,RC,87529,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,113.9,
MICROALBUMIN (RANDOM URINE) (IN-HOUSE),17600178,CDM,301,RC,82043,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,6.61,45.9,
FRAGILE X DNA& CHROMOSOME ANALYSIS BLOOD,17600180,CDM,310,RC,81243,HCPCS,OUTPATIENT,,,555.00,222.00,,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,71.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,71.3,471.75,
EPINEPHRINE/NOREPINEPHRINE,17600181,CDM,301,RC,82384,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,89.54,272,,,fee schedule,272% of BCBS fee schedule,89.54,272,,,fee schedule,272% of BCBS fee schedule,89.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,31.56,90.95,
.IGA REFLEX,17600182,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,42.00,16.80,,8.61,100,,,fee schedule,100% of Aetna fee schedule,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,8.61,35.9,
"VITAMIN D,1,25-HYDROXY",17600190,CDM,301,RC,82652,HCPCS,OUTPATIENT,,,172.00,68.80,,,,,,other ,not seperately reimbursable,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,148.59,272,,,fee schedule,272% of BCBS fee schedule,148.59,272,,,fee schedule,272% of BCBS fee schedule,148.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,103.2,60,,82.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,120.4,70,,96.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,55.04,32,,44.03,percent of total billed charges,32% of total billed charges,48.12,148.59,
TETANUS ANTIBODY TITRES,17600191,CDM,302,RC,86774,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,57.12,272,,,fee schedule,272% of BCBS fee schedule,57.12,272,,,fee schedule,272% of BCBS fee schedule,57.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,18.5,57.12,
VITAMIN A(RETINOL),17600192,CDM,301,RC,84590,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,44.74,272,,,fee schedule,272% of BCBS fee schedule,44.74,272,,,fee schedule,272% of BCBS fee schedule,44.74,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,14.51,45.05,
"CHLAMYDIA CULTURE-SWAB,FLUID,BIOP",17600195,CDM,306,RC,87110,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,63.84,272,,,fee schedule,272% of BCBS fee schedule,63.84,272,,,fee schedule,272% of BCBS fee schedule,63.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.5,66.3,
PH(BODY FLUID),17600196,CDM,301,RC,83986,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,13.82,272,,,fee schedule,272% of BCBS fee schedule,13.82,272,,,fee schedule,272% of BCBS fee schedule,13.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,4.47,15.3,
PINWORM EXAM,17600197,CDM,306,RC,87172,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
ACTIVATED PROTEIN C RESISTANCE,17600198,CDM,305,RC,85307,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
BF AMYLASE(BODY FLUID),17600199,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,8.1,59.5,
ANTI-MITOCHONDRIAL ANTIBODY,17600200,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
ANNA-1,17600201,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,15.06,46.54,
.HEP A ANTIBODY TOTAL w/Reflex to  IgM,17600202,CDM,302,RC,86708,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,46.57,272,,,fee schedule,272% of BCBS fee schedule,46.57,272,,,fee schedule,272% of BCBS fee schedule,46.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,15.48,55.25,
MYOGLOBIN-SERUM,17600203,CDM,301,RC,83874,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.83,272,,,fee schedule,272% of BCBS fee schedule,49.83,272,,,fee schedule,272% of BCBS fee schedule,49.83,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.15,49.83,
"NICOTINE, QUANTITATIVE (URINE)",17600204,CDM,301,RC,80323,HCPCS,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,93.32,272,,,fee schedule,272% of BCBS fee schedule,93.32,272,,,fee schedule,272% of BCBS fee schedule,93.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,93.32,
OSTEOCALCIN(SERUM),17600205,CDM,301,RC,83937,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,77.3,272,,,fee schedule,272% of BCBS fee schedule,77.3,272,,,fee schedule,272% of BCBS fee schedule,77.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,79.05,
INFLUENZA A & B(NASAL SWAB),17600210,CDM,306,RC,87804,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,20.68,93.5,
"BB RBC LEUKO REDUCED, EACH UNIT",17600211,CDM,390,RC,P9016,HCPCS,OUTPATIENT,,,272.92,109.17,,,,,,other ,not seperately reimbursable,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,282.88,272,,,fee schedule,272% of BCBS fee schedule,282.88,272,,,fee schedule,272% of BCBS fee schedule,282.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,163.75,60,,131,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,231.98,85,,185.58,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,191.04,70,,152.83,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,87.33,32,,69.86,percent of total billed charges,32% of total billed charges,87.33,282.88,
"BB PLATELETS,EACH UNIT",17600212,CDM,390,RC,P9019,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,119.68,272,,,fee schedule,272% of BCBS fee schedule,119.68,272,,,fee schedule,272% of BCBS fee schedule,119.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
STREP SCREEN (CULTURE GROUP A),17600213,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,8.28,46.75,
BB FRESH FROZEN PLASMA SGLE DNR,17600214,CDM,390,RC,P9017,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,122.4,272,,,fee schedule,272% of BCBS fee schedule,122.4,272,,,fee schedule,272% of BCBS fee schedule,122.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
INSULIN,17600215,CDM,301,RC,83525,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.15,272,,,fee schedule,272% of BCBS fee schedule,44.15,272,,,fee schedule,272% of BCBS fee schedule,44.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,14.28,44.2,
"T3 TOTAL, RIA(TRIIODOTHYRONINE)",17600216,CDM,301,RC,84480,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,54.73,272,,,fee schedule,272% of BCBS fee schedule,54.73,272,,,fee schedule,272% of BCBS fee schedule,54.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,17.72,55.25,
T4 UPTAKE,17600218,CDM,301,RC,84479,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,8.08,25,
"****THYROXINE, TOTAL(T4)  DO NOT USE",17600219,CDM,301,RC,84436,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,26.55,272,,,fee schedule,272% of BCBS fee schedule,26.55,272,,,fee schedule,272% of BCBS fee schedule,26.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,8.58,61.2,
T3 REVERSE,17600220,CDM,301,RC,84482,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,59.11,272,,,fee schedule,272% of BCBS fee schedule,59.11,272,,,fee schedule,272% of BCBS fee schedule,59.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,19.7,60.35,
"BB  PLASMA,POOLED MULT DNR,FROZEN",17600221,CDM,390,RC,P9023,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
"*BB RBC, LEUKOCYTES REDUCED STORAGE FEE",17600222,CDM,390,RC,P9016,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,282.88,272,,,fee schedule,272% of BCBS fee schedule,282.88,272,,,fee schedule,272% of BCBS fee schedule,282.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,282.88,
"BB PLATELETS LEUKO REDUCED, APHERESIS",17600223,CDM,390,RC,P9034,HCPCS,OUTPATIENT,,,675.00,270.00,,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405,60,,324,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,472.5,70,,378,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,573.75,
"BB PLATELETS,LEUKOCYTES",17600224,CDM,390,RC,P9031,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
GIARDIA LAMBLIA AB.IFA(SERUM),17600225,CDM,302,RC,86674,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,18.4,55.25,
"HEP C RNA GENOTYPE,LIPA",17600226,CDM,306,RC,87902,HCPCS,OUTPATIENT,,,795.00,318.00,,,,,,other ,not seperately reimbursable,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,477,60,,381.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,321.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,675.75,85,,540.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,556.5,70,,445.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,254.4,32,,203.52,percent of total billed charges,32% of total billed charges,254.4,675.75,
ISOLA OR EXTRCT OF HIGHTLY PRFIED N ACID,17600227,CDM,302,RC,83891,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
REVERSE TRANSCRIPTION,17600228,CDM,302,RC,83902,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
"AMPL OF PAT NUC ACID, MULTIPLER",17600229,CDM,302,RC,83901,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
SEPERATION BY GEL ELECTROPHRESIS,17600230,CDM,302,RC,83894,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
MUTATION ID BY SEQUENCING#1,17600231,CDM,302,RC,83904,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
MYTATION ID BY SEQUENCING#2,17600232,CDM,302,RC,83904,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
SM-RNP ANTIBODY,17600233,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
INTERPRETATION AND REPORT,17600234,CDM,310,RC,83912,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
LEGIONELLA ANTIGEN URINE,17600235,CDM,306,RC,87449,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,45.1,272,,,fee schedule,272% of BCBS fee schedule,45.1,272,,,fee schedule,272% of BCBS fee schedule,45.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,14.97,46.75,
"IRON, URINE 24HR",17600236,CDM,301,RC,83540,HCPCS,OUTPATIENT,,,52.00,20.80,,5.99,100,,,fee schedule,100% of Aetna fee schedule,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,5.99,44.2,
DARVOCET URINE,17600237,CDM,301,RC,80367,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
ACETAMINOPHEN(URINE),17600238,CDM,301,RC,82003,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
"CHROMATOGRAPHY, QUANT, COLUMN",17600239,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,79.00,31.60,,17.37,100,,,fee schedule,100% of Aetna fee schedule,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,17.37,67.15,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #1,17600240,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #2,17600241,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #3,17600242,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #4,17600243,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #5,17600244,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #6,17600245,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #7,17600246,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #8,17600247,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #9,17600248,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #10,17600249,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #11,17600250,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #12,17600251,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
RAST PEANUTS,17600253,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
"ALDOSTERONE, SERUM",17600254,CDM,301,RC,82088,HCPCS,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,157.32,272,,,fee schedule,272% of BCBS fee schedule,157.32,272,,,fee schedule,272% of BCBS fee schedule,157.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,50.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,157.32,
ISLET CELL ANTBDY SCRN W/REFLEX TO TITER,17600255,CDM,302,RC,86341,HCPCS,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,29.46,154.7,
HIV 1 INTEGRASE GENOTYPING,17600256,CDM,306,RC,87906,HCPCS,OUTPATIENT,,,550.00,220.00,,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330,60,,264,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,160.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,467.5,85,,374,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,385,70,,308,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,160.91,467.5,
"METANEPHRINES, PLASMA",17600257,CDM,301,RC,83835,HCPCS,OUTPATIENT,,,141.00,56.40,,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,21.17,119.85,
****THYROID HORMONE(T3 UPTAKE)DO NOT USE,17600258,CDM,301,RC,84479,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,8.08,25,
****THYROXINE TOTAL DO NOT USE,17600259,CDM,301,RC,84436,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,26.55,272,,,fee schedule,272% of BCBS fee schedule,26.55,272,,,fee schedule,272% of BCBS fee schedule,26.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,8.58,61.2,
FREE THYROXINE INDEX(FTI),17600260,CDM,301,RC,84439,HCPCS,OUTPATIENT,,,68.00,27.20,,8.35,100,,,fee schedule,100% of Aetna fee schedule,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,8.35,57.8,
THYROTROPIN RELEASING HORMONE,17600261,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
HBSAG (HEP B SURF AG),17600262,CDM,306,RC,87340,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,38.81,272,,,fee schedule,272% of BCBS fee schedule,38.81,272,,,fee schedule,272% of BCBS fee schedule,38.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,12.91,40.8,
SODIUM URINE(RANDOM),17600263,CDM,301,RC,84300,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.77,272,,,fee schedule,272% of BCBS fee schedule,18.77,272,,,fee schedule,272% of BCBS fee schedule,18.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,6.32,50.15,
POTASSIUM URINE-RANDOM,17600264,CDM,301,RC,84133,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,5.91,21.25,
RAST CAT DANDER,17600265,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
BUN(RANDOM URINE),17600269,CDM,301,RC,84540,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.95,19.55,
CREATININE(RANDOM URINE),17600270,CDM,301,RC,82570,HCPCS,OUTPATIENT,,,37.00,14.80,,4.79,100,,,fee schedule,100% of Aetna fee schedule,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,4.79,31.45,
ANTI-DNASE B ANTIBODY,17600271,CDM,302,RC,86215,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,51.16,272,,,fee schedule,272% of BCBS fee schedule,51.16,272,,,fee schedule,272% of BCBS fee schedule,51.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,16.56,88.4,
VON WILLEBRAND FACTOR ANTIGEN  LEVEL,17600272,CDM,305,RC,85246,HCPCS,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,28.67,88.59,
TBG (THYROXINE BINDING GLOBULIN,17600273,CDM,301,RC,84442,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.63,272,,,fee schedule,272% of BCBS fee schedule,56.63,272,,,fee schedule,272% of BCBS fee schedule,56.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,18.47,56.95,
HIV RNA ULTRA SENSITIVE QNT PCR,17600275,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,421.00,168.40,,,,,,other ,not seperately reimbursable,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.6,60,,202.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,357.85,85,,286.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,294.7,70,,235.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,134.72,32,,107.78,percent of total billed charges,32% of total billed charges,106.37,357.85,
LYMPHOCYTE SUBSET PANEL 1-A,17600276,CDM,302,RC,86359,HCPCS,OUTPATIENT,,,168.00,67.20,,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,12.02,272,,,fee schedule,272% of BCBS fee schedule,12.02,272,,,fee schedule,272% of BCBS fee schedule,12.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,100.8,60,,80.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,12.02,142.8,
LYMPHOCYTE SUBSET PANEL 1-B,17600277,CDM,302,RC,86360,HCPCS,OUTPATIENT,,,223.00,89.20,,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,133.8,60,,107.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,156.1,70,,124.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,26.28,189.55,
LYMPHOCYTE SUBSET PANEL 1-C,17600278,CDM,302,RC,86355,HCPCS,OUTPATIENT,,,168.00,67.20,,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,60,,80.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,47.16,142.8,
ADRENAL AB SCREEN/REFLEX TO TITER,17600279,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,15.06,69.7,
INNER EAR ANTIGEN ASSAY,17600280,CDM,301,RC,84182,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,69.47,272,,,fee schedule,272% of BCBS fee schedule,69.47,272,,,fee schedule,272% of BCBS fee schedule,69.47,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,69.47,
HEP DELTA ANTIGEN,17600281,CDM,306,RC,87380,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,61.72,272,,,fee schedule,272% of BCBS fee schedule,61.72,272,,,fee schedule,272% of BCBS fee schedule,61.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,61.72,
"HEP E ANTIBODY (IgG,IgM)",17600282,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.1,49.75,
PORPHOBILINOGEN SCREEN (RANDON URINE),17600283,CDM,301,RC,84106,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,16.54,272,,,fee schedule,272% of BCBS fee schedule,16.54,272,,,fee schedule,272% of BCBS fee schedule,16.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,7.27,63.75,
"AMINOLEVULINIC ACID,DELTA (RANDOM)",17600284,CDM,301,RC,82135,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,63.54,272,,,fee schedule,272% of BCBS fee schedule,63.54,272,,,fee schedule,272% of BCBS fee schedule,63.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,20.56,63.54,
"SPECIFIC GRAVITY - FLUID, NOT URINE",17600285,CDM,301,RC,84315,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,9.68,272,,,fee schedule,272% of BCBS fee schedule,9.68,272,,,fee schedule,272% of BCBS fee schedule,9.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,4.1,46.75,
ANTBDY TO PCNA(PROLIFERATING CELL NU ANT,17600286,CDM,302,RC,86331,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.97,46.27,
HEP B CORE ANTIBODY IGM,17600287,CDM,302,RC,86705,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,44.25,272,,,fee schedule,272% of BCBS fee schedule,44.25,272,,,fee schedule,272% of BCBS fee schedule,44.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,14.71,46.75,
...HEP B CORE TOTAL ANTIBODY,17600288,CDM,302,RC,86704,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,45.32,272,,,fee schedule,272% of BCBS fee schedule,45.32,272,,,fee schedule,272% of BCBS fee schedule,45.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,15.06,45.32,
HEP A (IGM),17600289,CDM,302,RC,86709,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,42.3,272,,,fee schedule,272% of BCBS fee schedule,42.3,272,,,fee schedule,272% of BCBS fee schedule,42.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,14.07,44.2,
TZANK SMEAR,17600291,CDM,306,RC,87207,HCPCS,OUTPATIENT,,,152.00,60.80,,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,23.12,272,,,fee schedule,272% of BCBS fee schedule,23.12,272,,,fee schedule,272% of BCBS fee schedule,23.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,91.2,60,,72.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,106.4,70,,85.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,7.48,129.2,
NT-proBNP,17600292,CDM,301,RC,83880,HCPCS,OUTPATIENT,,,100.00,40.00,,31.43,100,,,fee schedule,100% of Aetna fee schedule,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,49.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,31.43,85,
DRUG SCRN#2 COMPREHENSIVE(SERUM)MEDICAL,17600293,CDM,301,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DRUG SCRN#3 COMPREHENSIVE(SERUM)MEDICAL,17600294,CDM,301,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
DRUG SCRN#4 COMPREHENSIVE(SERUM)MEDICAL,17600295,CDM,301,RC,80320,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,41.72,272,,,fee schedule,272% of BCBS fee schedule,41.72,272,,,fee schedule,272% of BCBS fee schedule,41.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
"WEST NILE VIRUS AB,CSF(IgM,IgG)",17600296,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,16.1,60.35,
"WEST NILE VIRUS AB,BLOOD(IgM,IgG)",17600297,CDM,301,RC,86788,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,21.06,60.35,
STRYCHNINE,17600298,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,71.00,28.40,,17.37,100,,,fee schedule,100% of Aetna fee schedule,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,17.37,65.52,
LEUKOCYTE ALKALINE PHOSPHATASE,17600299,CDM,305,RC,85540,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,33.21,272,,,fee schedule,272% of BCBS fee schedule,33.21,272,,,fee schedule,272% of BCBS fee schedule,33.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,10.75,72.25,
FETAL LUNG MATURITY,17600300,CDM,301,RC,83663,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,23.63,66.3,
NONE STRIFIED FATTY ACIDS(FREE FATTY ACI,17600301,CDM,301,RC,82725,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,32.5,272,,,fee schedule,272% of BCBS fee schedule,32.5,272,,,fee schedule,272% of BCBS fee schedule,32.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
KEPPRA(LEVETIRACETAM) LEVEL,17600302,CDM,301,RC,80177,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,16.56,63.75,
BETA 2 GLYCOPROTEIN 1 IGA ABS,17600303,CDM,302,RC,86146,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
BETA 2 GLYCOPROTEIN 1 IGM ABS,17600304,CDM,302,RC,86146,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
BETA 2 GLYCOPROTEIN 1 IGG ABS,17600305,CDM,302,RC,86146,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
CHROMATIN  ABS IGG,17600306,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
LS RATIO,17600307,CDM,301,RC,83661,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,74.15,272,,,fee schedule,272% of BCBS fee schedule,74.15,272,,,fee schedule,272% of BCBS fee schedule,74.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,74.15,
KLEIHAUER BETKE (FETAL CELL STAIN),17600308,CDM,305,RC,85460,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.87,272,,,fee schedule,272% of BCBS fee schedule,29.87,272,,,fee schedule,272% of BCBS fee schedule,29.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,9.66,29.87,
RASH WALNUT,17600309,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
"CHROMOSOME ANALYSIS,BLOOD#1",17600310,CDM,305,RC,88230,HCPCS,OUTPATIENT,,,492.00,196.80,,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,449.75,272,,,fee schedule,272% of BCBS fee schedule,449.75,272,,,fee schedule,272% of BCBS fee schedule,449.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,295.2,60,,236.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,145.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,418.2,85,,334.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,344.4,70,,275.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,157.44,32,,125.95,percent of total billed charges,32% of total billed charges,145.61,449.75,
"CHROMOSOME ANALYSIS, BLOOD#2",17600311,CDM,305,RC,88262,HCPCS,OUTPATIENT,,,556.00,222.40,,,,,,other ,not seperately reimbursable,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,481.2,272,,,fee schedule,272% of BCBS fee schedule,481.2,272,,,fee schedule,272% of BCBS fee schedule,481.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,333.6,60,,266.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,389.2,70,,311.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,177.92,32,,142.34,percent of total billed charges,32% of total billed charges,156.86,481.2,
"CHROMOSOME ANALYSIS, BLOOD#3",17600312,CDM,305,RC,88291,HCPCS,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,9.57,272,,,fee schedule,272% of BCBS fee schedule,9.57,272,,,fee schedule,272% of BCBS fee schedule,9.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,9.57,75.65,
GLUCOSE 24HR URINE OR(RANDOM),17600313,CDM,301,RC,82945,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,4.91,34.85,
HIV RAPID TEST,17600314,CDM,302,RC,86701,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,34.3,272,,,fee schedule,272% of BCBS fee schedule,34.3,272,,,fee schedule,272% of BCBS fee schedule,34.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,11.11,56.1,
HERPES 1/2 IgM  W/REFLEX,17600315,CDM,302,RC,86695,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.48,50.92,
DAU (UR-DRUG SCRN) - INHOUSE,17600316,CDM,301,RC,80305,HCPCS,OUTPATIENT,,,276.00,110.40,,10.1,100,,,fee schedule,100% of Aetna fee schedule,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165.6,60,,132.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,10.1,234.6,
DAU (UR-DRUG SCREEN)- TRIAGE TOX,17600317,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,155.00,62.00,,53.87,100,,,fee schedule,100% of Aetna fee schedule,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,93,60,,74.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,108.5,70,,86.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,131.75,
"WEST NILE VIRUS AB,IGM",17600320,CDM,301,RC,86789,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,17.98,60.35,
THERMOACTINOMYCES AB,17600321,CDM,302,RC,86331,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,46.27,
MICROPOLYSPORA AB,17600322,CDM,302,RC,86331,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,46.27,
PIGEON SERUM AB,17600323,CDM,302,RC,86001,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
CA-27.29,17600346,CDM,302,RC,86300,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.01,70.55,
"GONORRHEA RNA,TMA",17600348,CDM,306,RC,87591,HCPCS,OUTPATIENT,,,121.00,48.40,,32.5,100,,,fee schedule,100% of Aetna fee schedule,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.6,60,,58.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,84.7,70,,67.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,32.5,102.85,
SEX HORMONE BINDING GLOBULIN,17600349,CDM,301,RC,84270,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,30.06,272,,,fee schedule,272% of BCBS fee schedule,30.06,272,,,fee schedule,272% of BCBS fee schedule,30.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
"****CHLAMDIA DNA,PCR",17600350,CDM,306,RC,87491,HCPCS,OUTPATIENT,,,134.00,53.60,,32.5,100,,,fee schedule,100% of Aetna fee schedule,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,32.5,113.9,
MEASLES AB IGM,17600357,CDM,302,RC,86765,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,16.1,59.5,
PLASMA METANEPHRINES,17600359,CDM,301,RC,83835,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,21.17,65.42,
RAST SOYBEAN,17600365,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
TACROLIMUS(FK506)-PROGRAF,17600367,CDM,301,RC,80197,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,17.16,73.95,
PROLACTIN,17600387,CDM,301,RC,84146,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,24.22,90.95,
DRUG SCREEN GENERAL,17600402,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
EPINEPHRINE,17600403,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,97.00,38.80,,17.37,100,,,fee schedule,100% of Aetna fee schedule,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,17.37,82.45,
"**TOXICOLOGY, SERUM/PLASMA",17600404,CDM,301,RC,80321,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,41.72,272,,,fee schedule,272% of BCBS fee schedule,41.72,272,,,fee schedule,272% of BCBS fee schedule,41.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
CULTURE BLOOD #2,17600406,CDM,306,RC,87040,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,12.9,40.8,
"IGA,IGG,IGM)IMMUNOGLOBULIN PROFILE",17600456,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,91.00,36.40,,8.61,100,,,fee schedule,100% of Aetna fee schedule,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,8.61,77.35,
"EHRLICHIA  ANTIBODY PANEL(IgG,IgM)",17600457,CDM,302,RC,86666,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,12.72,90.1,
EHRLICHIC ANTIBODY PANEL #2,17600458,CDM,302,RC,86666,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
EHRLICHIC ANTIBODY PANEL #3,17600459,CDM,302,RC,86666,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
EHRLICHIC ANTIBODY PANEL #4,17600460,CDM,302,RC,86666,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
ACETAMINOPHEN TX LVL,17600478,CDM,301,RC,80143,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,23.3,77.35,
VITAMIN B12,17600486,CDM,301,RC,82607,HCPCS,OUTPATIENT,,,104.81,41.92,,13.96,100,,,fee schedule,100% of Aetna fee schedule,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,62.89,60,,50.31,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,89.09,85,,71.27,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,73.37,70,,58.7,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,33.54,32,,26.83,percent of total billed charges,32% of total billed charges,13.96,89.09,
XYLOSE (D-XYLOSE),17600494,CDM,301,RC,84620,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,45.72,272,,,fee schedule,272% of BCBS fee schedule,45.72,272,,,fee schedule,272% of BCBS fee schedule,45.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,16.13,96.9,
PORPHYRINE (STOOL),17600496,CDM,301,RC,84126,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,98.33,272,,,fee schedule,272% of BCBS fee schedule,98.33,272,,,fee schedule,272% of BCBS fee schedule,98.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,98.33,
ACETONE(BLOOD),17600502,CDM,301,RC,82009,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,17.44,272,,,fee schedule,272% of BCBS fee schedule,17.44,272,,,fee schedule,272% of BCBS fee schedule,17.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,5.65,31.45,
"ACID PHOS,PROSTATIC",17600510,CDM,301,RC,84066,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,37.29,272,,,fee schedule,272% of BCBS fee schedule,37.29,272,,,fee schedule,272% of BCBS fee schedule,37.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,37.29,
B CELL TOTAL COUNT,17600512,CDM,302,RC,86357,HCPCS,OUTPATIENT,,,168.00,67.20,,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,60,,80.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,47.16,142.8,
P1NP Q3P,17600513,CDM,301,RC,82523,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
ZIKA VIRUS RNA PCR Q3P,17600514,CDM,306,RC,87662,HCPCS,OUTPATIENT,,,143.00,57.20,,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.8,60,,68.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,100.1,70,,80.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,121.55,
ALBUMIN,17600528,CDM,301,RC,82040,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,15.42,272,,,fee schedule,272% of BCBS fee schedule,15.42,272,,,fee schedule,272% of BCBS fee schedule,15.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,6.18,42.5,
ALCOHOL (MEDICAL),17600536,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,81.00,32.40,,53.87,100,,,fee schedule,100% of Aetna fee schedule,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,77.67,
ALCOHOL CHAIN OF CUSTODY,17600537,CDM,301,RC,99000,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
ALDOLASE,17600544,CDM,301,RC,82085,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,37.48,272,,,fee schedule,272% of BCBS fee schedule,37.48,272,,,fee schedule,272% of BCBS fee schedule,37.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.13,37.48,
ALKALINE PHOS (ALP),17600551,CDM,301,RC,84075,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,6.47,49.3,
SULFATIDE ANTIBODIES,17600553,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,49.99,
CBC (HEMOGRAM),17600555,CDM,305,RC,85027,HCPCS,OUTPATIENT,,,43.00,17.20,,5.99,100,,,fee schedule,100% of Aetna fee schedule,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,5.99,36.55,
RESPIRATORY SYNCYTIAL VIRUS (RSV) BY DFA,17600556,CDM,306,RC,87280,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
NUCLEIC ACID PROBE,17600558,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
MOLECULAR DIAG,17600559,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
CHEMILUMINESCENT ASSAY,17600560,CDM,301,RC,82397,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,17.65,85,
ZARONTIN (ETHOSUXIMIDE),17600562,CDM,301,RC,80168,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,63.08,272,,,fee schedule,272% of BCBS fee schedule,63.08,272,,,fee schedule,272% of BCBS fee schedule,63.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,20.42,63.08,
****OPIATE ID (ENDORPHIN OPRITE,17600565,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
RSV,17600566,CDM,306,RC,87280,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
LEIDEN 5,17600567,CDM,310,RC,81241,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,91.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,91.71,
"RAST ANIMAL(DOGS,CATS,HORSES)",17600570,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,34.00,13.60,,4.83,100,,,fee schedule,100% of Aetna fee schedule,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,4.83,28.9,
RAST FIRE ANT # 27398,17600571,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,23.00,9.20,,4.83,100,,,fee schedule,100% of Aetna fee schedule,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,4.83,20.16,
EPSTEIN  BARR VIRUS EARLY ANTIGEN AD IG,17600572,CDM,302,RC,86663,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,50.65,
TOXOPLASMA GONDII AB IGM,17600573,CDM,302,RC,86778,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,55.6,272,,,fee schedule,272% of BCBS fee schedule,55.6,272,,,fee schedule,272% of BCBS fee schedule,55.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,55.6,
EPSTEIN  BARR VIRUS NUCLEAR AG AB IGG,17600574,CDM,302,RC,86664,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.11,59.5,
C-PEPTIDE,17600582,CDM,301,RC,84681,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,72.13,272,,,fee schedule,272% of BCBS fee schedule,72.13,272,,,fee schedule,272% of BCBS fee schedule,72.13,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,72.13,
MYCOPHENOLIC ACID,17600583,CDM,301,RC,80180,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
INFLUENZA A&B (BLOOD)#2,17600584,CDM,302,RC,86710,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.33,272,,,fee schedule,272% of BCBS fee schedule,52.33,272,,,fee schedule,272% of BCBS fee schedule,52.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,16.93,53.55,
.AMMONIA (REFERENCE),17600585,CDM,301,RC,82140,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,18.21,56.25,
INFLUENZA A&B (BLOOD) #1,17600586,CDM,302,RC,86710,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.33,272,,,fee schedule,272% of BCBS fee schedule,52.33,272,,,fee schedule,272% of BCBS fee schedule,52.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,16.93,53.55,
DRUG SCREEN-NON CHAIN OF CUSTODY,17600587,CDM,301,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DRUG SCREEN-MEDPRO E PANEL,17600588,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
AFP-(QUAD) SCREEN,17600589,CDM,301,RC,82677,HCPCS,OUTPATIENT,,,170.00,68.00,,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,93.38,272,,,fee schedule,272% of BCBS fee schedule,93.38,272,,,fee schedule,272% of BCBS fee schedule,93.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,102,60,,81.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,119,70,,95.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,30.22,144.5,
AFP-PENTA SCREEN #2,17600590,CDM,301,RC,81512,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
AFP-PENTA SCREEN #4,17600591,CDM,302,RC,86336,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,19.48,93.5,
.HEP B SURF AG,17600592,CDM,306,RC,87340,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,38.81,272,,,fee schedule,272% of BCBS fee schedule,38.81,272,,,fee schedule,272% of BCBS fee schedule,38.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,12.91,38.81,
AMYLASE,17600593,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,8.1,59.5,
APOLIPOPROTEIN B,17600597,CDM,301,RC,82172,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
APOLIPOPROTEIN A1,17600598,CDM,301,RC,82172,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,55.25,
TISSUE BIOPSY,17600601,CDM,302,RC,88233,HCPCS,OUTPATIENT,,,570.00,228.00,,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,543.29,272,,,fee schedule,272% of BCBS fee schedule,543.29,272,,,fee schedule,272% of BCBS fee schedule,543.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,342,60,,273.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,175.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,399,70,,319.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,175.91,543.29,
2 KARYOTYPES W/BANDING,17600602,CDM,302,RC,88262,HCPCS,OUTPATIENT,,,503.00,201.20,,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,481.2,272,,,fee schedule,272% of BCBS fee schedule,481.2,272,,,fee schedule,272% of BCBS fee schedule,481.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,301.8,60,,241.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,156.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,352.1,70,,281.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,160.96,32,,128.77,percent of total billed charges,32% of total billed charges,156.86,481.2,
KETOSTEROIDS-17 FRACTIONATED,17600614,CDM,301,RC,83593,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,101.54,272,,,fee schedule,272% of BCBS fee schedule,101.54,272,,,fee schedule,272% of BCBS fee schedule,101.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,101.54,
DRUG SCREEN STUDENT,17600615,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
BILIRUBIN-TOTAL,17600627,CDM,301,RC,82247,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,6.27,34,
"METHYL, ALCOHOL BLOOD",17600630,CDM,301,RC,84600,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,62.04,272,,,fee schedule,272% of BCBS fee schedule,62.04,272,,,fee schedule,272% of BCBS fee schedule,62.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,21.38,62.04,
ETHYLENE GLYCOL,17600633,CDM,301,RC,82693,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,36.99,272,,,fee schedule,272% of BCBS fee schedule,36.99,272,,,fee schedule,272% of BCBS fee schedule,36.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,18.62,60.35,
LEAD (MEDICAL),17600635,CDM,301,RC,83655,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.13,46.75,
DRUG SCRN#1 COMPREHENSIVE(SERUM)MEDICAL,17600636,CDM,301,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
PROPOXYPHENE-PANEL 10-ABUSE,17600637,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
METHAQUALONE-PANEL 10-ABUSE,17600638,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
METHADONE-PANEL 10-ABUSE,17600639,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
CANNABINOIDS(SERUM) PANEL 10-ABUSE,17600640,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
PHENCYCLIDINE  URINE SCREEN,17600641,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
0*****OPIATES-PANEL 10-ABUSE,17600642,CDM,301,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
COCAINE & METABOLITE(SERUM)-PANEL 10-ABU,17600643,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
BENZODIAZEPINES(SERUM)-PANEL 10-ABUSE,17600644,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
BARBITURATES-PANEL 10-ABUSE,17600645,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
AMPHETAMINES SCREEN W/CONFIRMATION,17600646,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,82.00,32.80,,53.87,100,,,fee schedule,100% of Aetna fee schedule,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,77.67,
"OCCULT BLOOD, GASTRIC CONTENTS SCRN",17600647,CDM,301,RC,82271,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,12.54,272,,,fee schedule,272% of BCBS fee schedule,12.54,272,,,fee schedule,272% of BCBS fee schedule,12.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.65,17.85,
BF POTASSIUM BODY FLUIDS,17600648,CDM,301,RC,84133,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,5.91,67.15,
"MDMA, BLOOD (ECTASY)",17600649,CDM,301,RC,82145,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
BROMIDE,17600650,CDM,301,RC,83018,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,84.78,
"BF SODIUM, BODY FLUID",17600651,CDM,301,RC,84302,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,6.07,50.15,
RAST RYE,17600652,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST BARLEY,17600653,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST OATS,17600654,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST TOMATO,17600656,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST POTATO,17600657,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST MALT,17600658,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST PECAN,17600659,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST LETTUCE,17600660,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
HEP B CORE TOTAL ANTIBODY,17600663,CDM,302,RC,86704,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,45.32,272,,,fee schedule,272% of BCBS fee schedule,45.32,272,,,fee schedule,272% of BCBS fee schedule,45.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
.HEP B CORE ANTIBODY IGM,17600664,CDM,302,RC,86705,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,44.25,272,,,fee schedule,272% of BCBS fee schedule,44.25,272,,,fee schedule,272% of BCBS fee schedule,44.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.71,45.9,
HEP Be ANTIGEN,17600665,CDM,306,RC,87350,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,43.3,272,,,fee schedule,272% of BCBS fee schedule,43.3,272,,,fee schedule,272% of BCBS fee schedule,43.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,14.41,45.05,
"HOMOVANILLLIC ACID, 24 HR URINE",17600666,CDM,301,RC,83150,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
INSECT PANEL-HONEY BEE IGE,17600669,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,23.00,9.20,,4.83,100,,,fee schedule,100% of Aetna fee schedule,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,4.83,20.16,
INSECT PANEL-PAPER WASP IGE,17600670,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,23.00,9.20,,4.83,100,,,fee schedule,100% of Aetna fee schedule,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,4.83,20.16,
INSECT PANEL-WHITE-FACED HORNET IGE,17600671,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,23.00,9.20,,4.83,100,,,fee schedule,100% of Aetna fee schedule,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,4.83,20.16,
INSECT PANEL-YELLOW HORNET IGE,17600672,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,23.00,9.20,,4.83,100,,,fee schedule,100% of Aetna fee schedule,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,4.83,20.16,
"#1ROCKEY MT SPOTTED FEVER,RICKETTSIA",17600673,CDM,302,RC,86757,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,24.18,70.55,
"#2ROCKEY MT SPOTTED FEVER,RICKETTSIA",17600674,CDM,302,RC,86757,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,24.18,70.55,
INSECT PANEL-YELLOW JACKEY IGE,17600675,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,23.00,9.20,,4.83,100,,,fee schedule,100% of Aetna fee schedule,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,4.83,20.16,
BUN,17600676,CDM,301,RC,84520,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.23,272,,,fee schedule,272% of BCBS fee schedule,15.23,272,,,fee schedule,272% of BCBS fee schedule,15.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,4.93,15.3,
SCL-70  AB (SCLERODERMA ANTIBODY),17600685,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
COPPER (24 HR URINE),17600690,CDM,301,RC,82525,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.51,47.93,
CHLORIDE (RANDOM URINE),17600691,CDM,301,RC,82436,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,12.24,272,,,fee schedule,272% of BCBS fee schedule,12.24,272,,,fee schedule,272% of BCBS fee schedule,12.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.18,20.4,
CALCIUM (BLOOD),17600692,CDM,301,RC,82310,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,19.88,272,,,fee schedule,272% of BCBS fee schedule,19.88,272,,,fee schedule,272% of BCBS fee schedule,19.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,6.45,20.4,
"CHLORIDE, 24 HOUR",17600693,CDM,301,RC,82436,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,12.24,272,,,fee schedule,272% of BCBS fee schedule,12.24,272,,,fee schedule,272% of BCBS fee schedule,12.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.18,20.4,
TISSUE(IgG)TRANSGLUTAMINASE (tTG),17600699,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
VANCOMYCIN (RANDOM) - REFERENCE,17600700,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,16.92,94.35,
CAROTENE,17600718,CDM,301,RC,82380,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.6,272,,,fee schedule,272% of BCBS fee schedule,35.6,272,,,fee schedule,272% of BCBS fee schedule,35.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,11.52,35.7,
"CANDIDA SPECIES,PCR",17600720,CDM,306,RC,87481,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
"C.THRACHOMATIS,PCR",17600721,CDM,306,RC,87491,HCPCS,OUTPATIENT,,,42.00,16.80,,32.5,100,,,fee schedule,100% of Aetna fee schedule,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
"N.GONORRHOEAE,PCR",17600722,CDM,306,RC,87591,HCPCS,OUTPATIENT,,,42.00,16.80,,32.5,100,,,fee schedule,100% of Aetna fee schedule,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
"LACTOBACILLUS SPECIES,PCR",17600723,CDM,306,RC,87498,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
"A.VAGINAE,PCR",17600724,CDM,306,RC,87498,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
"MEGASPHAERA SPECIES,PCR",17600725,CDM,306,RC,87498,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
"G.VAGINALIS, PCR",17600726,CDM,306,RC,87511,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
"T.VAGINALIS, PCR",17600727,CDM,306,RC,87661,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,43.86,
CHLORIDE,17600734,CDM,301,RC,82435,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,17.73,272,,,fee schedule,272% of BCBS fee schedule,17.73,272,,,fee schedule,272% of BCBS fee schedule,17.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,5.75,18.7,
CHLORIDE(FECES),17600736,CDM,301,RC,82438,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,6.25,28.9,
CHOLESTEROL,17600742,CDM,301,RC,82465,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,12.76,272,,,fee schedule,272% of BCBS fee schedule,12.76,272,,,fee schedule,272% of BCBS fee schedule,12.76,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,5.43,25.5,
CO2,17600767,CDM,301,RC,82374,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.1,19.55,
CK (CPK),17600775,CDM,301,RC,82550,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,25.16,272,,,fee schedule,272% of BCBS fee schedule,25.16,272,,,fee schedule,272% of BCBS fee schedule,25.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,8.13,59.5,
CK ISOENZYMES,17600783,CDM,301,RC,82552,HCPCS,OUTPATIENT,,,62.55,25.02,,,,,,other ,not seperately reimbursable,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,51.71,272,,,fee schedule,272% of BCBS fee schedule,51.71,272,,,fee schedule,272% of BCBS fee schedule,51.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.53,60,,30.02,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,53.17,85,,42.54,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,43.79,70,,35.03,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,20.02,32,,16.02,percent of total billed charges,32% of total billed charges,16.73,53.17,
CREATININE(24HR URINE),17600790,CDM,301,RC,82570,HCPCS,OUTPATIENT,,,37.00,14.80,,4.79,100,,,fee schedule,100% of Aetna fee schedule,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,4.79,31.45,
CREATININE (BLOOD),17600791,CDM,301,RC,82565,HCPCS,OUTPATIENT,,,24.00,9.60,,4.75,100,,,fee schedule,100% of Aetna fee schedule,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,19.77,272,,,fee schedule,272% of BCBS fee schedule,19.77,272,,,fee schedule,272% of BCBS fee schedule,19.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,4.75,20.4,
GFR (EST GLOMERULAR FILTRATION RATE),17600792,CDM,301,RC,82565,HCPCS,OUTPATIENT,,,24.00,9.60,,4.75,100,,,fee schedule,100% of Aetna fee schedule,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,19.77,272,,,fee schedule,272% of BCBS fee schedule,19.77,272,,,fee schedule,272% of BCBS fee schedule,19.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,4.75,20.4,
PROTHROMBIN(FACTOR II)20210G>A MUTATION,17600809,CDM,302,RC,81240,HCPCS,OUTPATIENT,,,476.00,190.40,,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.6,60,,228.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,404.6,85,,323.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,333.2,70,,266.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,82.11,404.6,
HEP A ANTIBODY IMMUNE STATUS,17600810,CDM,302,RC,86708,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,46.57,272,,,fee schedule,272% of BCBS fee schedule,46.57,272,,,fee schedule,272% of BCBS fee schedule,46.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.48,47.6,
FERRITIN,17600833,CDM,301,RC,82728,HCPCS,OUTPATIENT,,,91.00,36.40,,12.62,100,,,fee schedule,100% of Aetna fee schedule,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,52.58,272,,,fee schedule,272% of BCBS fee schedule,52.58,272,,,fee schedule,272% of BCBS fee schedule,52.58,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,12.62,77.35,
TRILEPTAL LEVEL (OXYCARBAZEPINE),17600840,CDM,301,RC,80183,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,16.56,53.55,
FOLIC ACID (FOLATE),17600841,CDM,301,RC,82746,HCPCS,OUTPATIENT,,,100.00,40.00,,13.61,100,,,fee schedule,100% of Aetna fee schedule,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,56.77,272,,,fee schedule,272% of BCBS fee schedule,56.77,272,,,fee schedule,272% of BCBS fee schedule,56.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,13.61,85,
LDL DIRECT CHOLESTEROL,17600842,CDM,301,RC,83721,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.83,272,,,fee schedule,272% of BCBS fee schedule,36.83,272,,,fee schedule,272% of BCBS fee schedule,36.83,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.12,36.83,
PNEUMOCYSTIS CARINII (jiroveci),17600853,CDM,306,RC,88312,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,103.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,200.6,
GGT,17600858,CDM,301,RC,82977,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,27.77,272,,,fee schedule,272% of BCBS fee schedule,27.77,272,,,fee schedule,272% of BCBS fee schedule,27.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,9,38.25,
RNP ANTIBODY,17600862,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
EPSTEIN (IGG IGM) BARR PANEL,17600871,CDM,302,RC,86663,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.4,51,
****EPSTEIN,17600873,CDM,302,RC,86664,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,19.11,59.05,
EPSTEIN (IgG) BARR AB VCA I,17600874,CDM,302,RC,86665,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,22.67,70.04,
TSH W/REFLEX FT4,17600875,CDM,301,RC,84443,HCPCS,OUTPATIENT,,,101.00,40.40,,15.56,100,,,fee schedule,100% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,64.84,272,,,fee schedule,272% of BCBS fee schedule,64.84,272,,,fee schedule,272% of BCBS fee schedule,64.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,15.56,85.85,
EPSTEIN (IgM) BARR AB VCA I,17600876,CDM,302,RC,86665,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,22.67,70.04,
METHADONE SCREEN,17600888,CDM,309,RC,80101,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
GLUCOSE TT(3HR),17600890,CDM,301,RC,82951,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,16.08,64.6,
AFP-PENTA SCREEN #3,17600891,CDM,301,RC,82105,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,64.76,272,,,fee schedule,272% of BCBS fee schedule,64.76,272,,,fee schedule,272% of BCBS fee schedule,64.76,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,20.96,100.3,
IODINE,17600892,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,55.00,22.00,,17.37,100,,,fee schedule,100% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.37,65.52,
FACTOR XII (HAGEMAN),17600934,CDM,305,RC,85280,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,74.72,272,,,fee schedule,272% of BCBS fee schedule,74.72,272,,,fee schedule,272% of BCBS fee schedule,74.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,24.18,74.72,
HDL CHOLESTEROL,17600940,CDM,301,RC,83718,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,31.61,272,,,fee schedule,272% of BCBS fee schedule,31.61,272,,,fee schedule,272% of BCBS fee schedule,31.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,10.23,32.3,
HEMOGLOBIN ELECTROPHORESIS,17600965,CDM,305,RC,83020,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,49.72,272,,,fee schedule,272% of BCBS fee schedule,49.72,272,,,fee schedule,272% of BCBS fee schedule,49.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,16.08,68.85,
RITALIN (METHYLPHENIDATE),17600976,CDM,301,RC,80360,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
***RAST,17600979,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST HOUSE DUST & MITES,17600980,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,34.00,13.60,,4.83,100,,,fee schedule,100% of Aetna fee schedule,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,4.83,28.9,
RAST WEEDS,17600981,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,34.00,13.60,,4.83,100,,,fee schedule,100% of Aetna fee schedule,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,4.83,28.9,
RAST TREES,17600982,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,34.00,13.60,,4.83,100,,,fee schedule,100% of Aetna fee schedule,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,4.83,28.9,
RAST CODFISH,17600983,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST MOLDS,17600984,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,34.00,13.60,,4.83,100,,,fee schedule,100% of Aetna fee schedule,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,4.83,28.9,
RAST GRASSES II,17600985,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST GRASSES I,17600986,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,34.00,13.60,,4.83,100,,,fee schedule,100% of Aetna fee schedule,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,4.83,28.9,
RAST FOOD SCREEN,17600987,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST GENERAL SCREEN,17600988,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RASH CLAM,17600989,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
CORONOVIRUS 2 SARS ANTIGEN,17600990,CDM,302,RC,87426,HCPCS,OUTPATIENT,,,41.38,16.55,,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.83,60,,19.86,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,35.17,85,,28.14,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,28.97,70,,23.18,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,35.17,
COVID-19 AG BY EIA ELISA FIA IMCA,17600991,CDM,302,RC,87426,HCPCS,OUTPATIENT,,,41.38,16.55,,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.83,60,,19.86,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,35.17,85,,28.14,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,28.97,70,,23.18,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,32,,10.59,percent of total billed charges,32% of total billed charges,13.24,35.17,
Z IRON-DO NOT USE,17601005,CDM,301,RC,83540,HCPCS,OUTPATIENT,,,29.00,11.60,,5.99,100,,,fee schedule,100% of Aetna fee schedule,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,5.99,25.02,
"SEROTONIN, SERUM",17601011,CDM,301,RC,84260,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,57.01,
IRON BIND CAP (TIBC)W/IRON,17601013,CDM,301,RC,83550,HCPCS,OUTPATIENT,,,41.77,16.71,,8.09,100,,,fee schedule,100% of Aetna fee schedule,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,33.73,272,,,fee schedule,272% of BCBS fee schedule,33.73,272,,,fee schedule,272% of BCBS fee schedule,33.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.06,60,,20.05,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,35.5,85,,28.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,29.24,70,,23.39,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,13.37,32,,10.7,percent of total billed charges,32% of total billed charges,8.09,35.5,
IRON,17601014,CDM,301,RC,83540,HCPCS,OUTPATIENT,,,52.00,20.80,,5.99,100,,,fee schedule,100% of Aetna fee schedule,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,5.99,44.2,
LACTIC ACID,17601021,CDM,301,RC,83605,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,41.21,272,,,fee schedule,272% of BCBS fee schedule,41.21,272,,,fee schedule,272% of BCBS fee schedule,41.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,14.46,42.5,
LACTIC ACID (CSF),17601022,CDM,301,RC,83605,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,41.21,272,,,fee schedule,272% of BCBS fee schedule,41.21,272,,,fee schedule,272% of BCBS fee schedule,41.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,14.46,42.5,
LDH,17601039,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,28.00,11.20,,5.59,100,,,fee schedule,100% of Aetna fee schedule,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,5.59,23.8,
LIPASE (BLOOD),17601047,CDM,301,RC,83690,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,26.57,272,,,fee schedule,272% of BCBS fee schedule,26.57,272,,,fee schedule,272% of BCBS fee schedule,26.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,8.61,59.5,
BF LIPASE (BODY FLUIDS),17601048,CDM,301,RC,83690,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,26.57,272,,,fee schedule,272% of BCBS fee schedule,26.57,272,,,fee schedule,272% of BCBS fee schedule,26.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,8.61,59.5,
LIPOPROTEIN ELECTROPHORESIS,17601054,CDM,301,RC,83701,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,46.54,
LITHIUM,17601062,CDM,301,RC,80178,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,25.51,272,,,fee schedule,272% of BCBS fee schedule,25.51,272,,,fee schedule,272% of BCBS fee schedule,25.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,8.26,46.75,
LIPOPROTEIN FRACTIONATED ION MOBILITY,17601064,CDM,301,RC,83704,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.73,
MAGNESIUM RBC(SEND-OUT),17601104,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,52.00,20.80,,6.2,100,,,fee schedule,100% of Aetna fee schedule,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,25.87,272,,,fee schedule,272% of BCBS fee schedule,25.87,272,,,fee schedule,272% of BCBS fee schedule,25.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,6.2,44.2,
PHOSPHORUS(PHOSPHATE),17601138,CDM,301,RC,84100,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.31,272,,,fee schedule,272% of BCBS fee schedule,18.31,272,,,fee schedule,272% of BCBS fee schedule,18.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,5.92,19.55,
AMMONIA 24HR URINE,17601140,CDM,301,RC,82140,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,18.21,56.25,
PKU,17601146,CDM,301,RC,84030,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,21.24,272,,,fee schedule,272% of BCBS fee schedule,21.24,272,,,fee schedule,272% of BCBS fee schedule,21.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.87,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,6.87,22.1,
RENIN,17601153,CDM,301,RC,84244,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,84.92,272,,,fee schedule,272% of BCBS fee schedule,84.92,272,,,fee schedule,272% of BCBS fee schedule,84.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,27.48,84.92,
HEPARIN ANTI XA,17601154,CDM,305,RC,85520,HCPCS,OUTPATIENT,,,177.97,71.19,,,,,,other ,not seperately reimbursable,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.78,60,,85.42,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,151.27,85,,121.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,124.58,70,,99.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,56.95,32,,45.56,percent of total billed charges,32% of total billed charges,16.36,151.27,
LYSOZYME(MURAMIDASE) SERUM,17601159,CDM,305,RC,85549,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,72.41,272,,,fee schedule,272% of BCBS fee schedule,72.41,272,,,fee schedule,272% of BCBS fee schedule,72.41,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,23.43,72.41,
MICROALBUMIN (RANDOM URINE)(REFERENCE),17601178,CDM,301,RC,82043,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,6.61,45.9,
POTASSIUM,17601179,CDM,301,RC,84132,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,17.73,272,,,fee schedule,272% of BCBS fee schedule,17.73,272,,,fee schedule,272% of BCBS fee schedule,17.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,5.95,20.4,
PROTEIN ELECT (SERUM),17601195,CDM,301,RC,84165,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,13.42,41.48,
SALICYLATE,17601203,CDM,301,RC,80179,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,23.3,68.85,
SCHILLING TEST (W/INTRINSIC FACTOR),17601211,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
SGOT (AST),17601229,CDM,301,RC,84450,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,19.94,272,,,fee schedule,272% of BCBS fee schedule,19.94,272,,,fee schedule,272% of BCBS fee schedule,19.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,6.47,21.25,
SGPT (ALT),17601237,CDM,301,RC,84460,HCPCS,OUTPATIENT,,,30.00,12.00,,4.91,100,,,fee schedule,100% of Aetna fee schedule,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,20.45,272,,,fee schedule,272% of BCBS fee schedule,20.45,272,,,fee schedule,272% of BCBS fee schedule,20.45,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,4.91,25.5,
SODIUM,17601252,CDM,301,RC,84295,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.55,272,,,fee schedule,272% of BCBS fee schedule,18.55,272,,,fee schedule,272% of BCBS fee schedule,18.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.01,19.55,
TRIGLYCERIDE,17601260,CDM,301,RC,84478,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,22.2,272,,,fee schedule,272% of BCBS fee schedule,22.2,272,,,fee schedule,272% of BCBS fee schedule,22.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,7.17,25.5,
TRIGLYCERIDE (BODY FLUID),17601266,CDM,301,RC,84478,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.2,272,,,fee schedule,272% of BCBS fee schedule,22.2,272,,,fee schedule,272% of BCBS fee schedule,22.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,7.17,22.95,
URIC ACID (URINE),17601278,CDM,301,RC,84560,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.35,19.55,
DEPAKENE (VALPROIC) TOTAL,17601286,CDM,301,RC,80164,HCPCS,OUTPATIENT,,,112.49,45.00,,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,36,32,,28.8,percent of total billed charges,32% of total billed charges,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.49,60,,53.99,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,95.62,85,,76.5,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,36,32,,28.8,percent of total billed charges,32% of total billed charges,78.74,70,,62.99,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,36,32,,28.8,percent of total billed charges,32% of total billed charges,16.92,95.62,
EXTRACTION FEE,17601310,CDM,300,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
"PROTEIN ELECTROPHORESIS,M,SPIKE,PROG",17601316,CDM,301,RC,84165,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,13.42,41.48,
"**PROTEIN ELECTROPHORESIS,M,SPIKE,PROG#2",17601317,CDM,301,RC,86334,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,86.25,272,,,fee schedule,272% of BCBS fee schedule,86.25,272,,,fee schedule,272% of BCBS fee schedule,86.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,86.25,
RETICULOCYTE COUNT,17601324,CDM,305,RC,85045,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,15.45,272,,,fee schedule,272% of BCBS fee schedule,15.45,272,,,fee schedule,272% of BCBS fee schedule,15.45,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,4.98,32.3,
CEA,17601328,CDM,300,RC,82378,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,73.25,272,,,fee schedule,272% of BCBS fee schedule,73.25,272,,,fee schedule,272% of BCBS fee schedule,73.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,23.7,73.25,
SKLSC SICKLE CELL SCREEN 1,17601330,CDM,300,RC,85660,HCPCS,OUTPATIENT,,,39.36,15.74,,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.62,60,,18.9,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,33.46,85,,26.77,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,27.55,70,,22.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,6.88,33.46,
SKLSC SICKLE CELL SCREEN 2,17601331,CDM,300,RC,85660,HCPCS,OUTPATIENT,,,39.36,15.74,,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.62,60,,18.9,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,33.46,85,,26.77,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,27.55,70,,22.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,6.88,33.46,
SKLSC SICKLE CELL SCREEN 3,17601332,CDM,300,RC,85660,HCPCS,OUTPATIENT,,,39.36,15.74,,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.62,60,,18.9,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,33.46,85,,26.77,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,27.55,70,,22.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,12.6,32,,10.08,percent of total billed charges,32% of total billed charges,6.88,33.46,
SOPHIA 2 FLU- SARS ANTIGEN FIA,17601333,CDM,300,RC,87428,HCPCS,OUTPATIENT,,,88.57,35.43,,,,,,other ,not seperately reimbursable,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.14,60,,42.51,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,75.28,85,,60.22,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,62,70,,49.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,28.34,32,,22.67,percent of total billed charges,32% of total billed charges,28.34,75.28,
FIBRIN SPLIT PRODUCT (FDP),17601377,CDM,305,RC,85362,HCPCS,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,26.57,272,,,fee schedule,272% of BCBS fee schedule,26.57,272,,,fee schedule,272% of BCBS fee schedule,26.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,8.61,39.95,
TP-PA TREPONEMA PALLIDUM ANTIBODY,17601379,CDM,302,RC,86780,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51.11,272,,,fee schedule,272% of BCBS fee schedule,51.11,272,,,fee schedule,272% of BCBS fee schedule,51.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.55,51.11,
CENTROMERE ANTIBODY SCREEN,17601380,CDM,302,RC,86038,HCPCS,OUTPATIENT,,,55.00,22.00,,11.19,100,,,fee schedule,100% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.65,272,,,fee schedule,272% of BCBS fee schedule,46.65,272,,,fee schedule,272% of BCBS fee schedule,46.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,11.19,46.75,
FIBRINOGEN,17601385,CDM,305,RC,85384,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,32.78,272,,,fee schedule,272% of BCBS fee schedule,32.78,272,,,fee schedule,272% of BCBS fee schedule,32.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,12.15,42.5,
BLEEDING TIME,17601427,CDM,305,RC,85002,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,17.38,272,,,fee schedule,272% of BCBS fee schedule,17.38,272,,,fee schedule,272% of BCBS fee schedule,17.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,6.02,22.95,
LE PREP(BODY FLUIDS ONLY),17601443,CDM,302,RC,86317,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.88,272,,,fee schedule,272% of BCBS fee schedule,57.88,272,,,fee schedule,272% of BCBS fee schedule,57.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.73,57.88,
MALARIA SMEAR,17601468,CDM,305,RC,87207,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.12,272,,,fee schedule,272% of BCBS fee schedule,23.12,272,,,fee schedule,272% of BCBS fee schedule,23.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,7.48,23.8,
PTT,17601476,CDM,305,RC,85730,HCPCS,OUTPATIENT,,,45.46,18.18,,5.57,100,,,fee schedule,100% of Aetna fee schedule,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,23.17,272,,,fee schedule,272% of BCBS fee schedule,23.17,272,,,fee schedule,272% of BCBS fee schedule,23.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,27.28,60,,21.82,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,38.64,85,,30.91,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,31.82,70,,25.46,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,14.55,32,,11.64,percent of total billed charges,32% of total billed charges,5.57,38.64,
PROTIME,17601518,CDM,305,RC,85610,HCPCS,OUTPATIENT,,,25.00,10.00,,3.64,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,15.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,3.64,21.25,
GM1 GANGLIOSIDE  ANTIBODY,17601524,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,21.58,77.35,
RETICULOCYTE COUNT (REFERENCE),17601534,CDM,305,RC,85044,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.38,17.85,
CHESTNUT (sweet),17601535,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
SEDRATE (ESR),17601542,CDM,305,RC,85652,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,10.42,272,,,fee schedule,272% of BCBS fee schedule,10.42,272,,,fee schedule,272% of BCBS fee schedule,10.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,3.37,15.3,
SICKLE CELL SCREEN,17601559,CDM,305,RC,85660,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,21.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,6.88,22.1,
ASO (ASO TITER),17601583,CDM,302,RC,86060,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,28.18,272,,,fee schedule,272% of BCBS fee schedule,28.18,272,,,fee schedule,272% of BCBS fee schedule,28.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,9.12,29.75,
AMMONIA (INHOUSE),17601585,CDM,301,RC,82140,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,18.21,56.25,
COLD AGGLUTININ TITER,17601591,CDM,302,RC,86157,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.14,272,,,fee schedule,272% of BCBS fee schedule,31.14,272,,,fee schedule,272% of BCBS fee schedule,31.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,10.07,31.45,
FEBRILE AGGLUTINATION,17601617,CDM,302,RC,86000,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,26.96,272,,,fee schedule,272% of BCBS fee schedule,26.96,272,,,fee schedule,272% of BCBS fee schedule,26.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,8.72,28.05,
FTA-ABS,17601625,CDM,302,RC,86780,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51.11,272,,,fee schedule,272% of BCBS fee schedule,51.11,272,,,fee schedule,272% of BCBS fee schedule,51.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.55,51.11,
HepaScor/Fibrosur(Liver Fibrosis Panel),17601627,CDM,310,RC,81599,HCPCS,OUTPATIENT,,,554.00,221.60,,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.4,60,,265.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,470.9,
MONO SCREEN (REFERENCE),17601641,CDM,302,RC,86308,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,6.47,30.6,
.RHEUMATOID FACTOR SCREEN (QUAL),17601658,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,7.67,22.1,
CYCLOSPORA & ISOPORA DIRECT EXAM,17601659,CDM,306,RC,87015,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.35,25.79,
CYCLOSPORA & ISOPORA DIRECT EXAM#2,17601660,CDM,306,RC,87207,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,23.12,272,,,fee schedule,272% of BCBS fee schedule,23.12,272,,,fee schedule,272% of BCBS fee schedule,23.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,7.48,23.12,
RPR,17601674,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
RPR TITER,17601685,CDM,302,RC,86593,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,17,272,,,fee schedule,272% of BCBS fee schedule,17,272,,,fee schedule,272% of BCBS fee schedule,17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,5.5,17,
VDRL (SERUM/CSF),17601708,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
BF PROTEIN TOTAL(BODY FLUID),17601732,CDM,301,RC,84157,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,5,16.15,
AMYLASE (URINE)RANDOM,17601781,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,8.1,59.5,
CYSTINE  QUANT(24 HR URINE),17601849,CDM,301,RC,82131,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,18.2,64.6,
HAPTOGLOBIN,17601872,CDM,301,RC,83010,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,48.55,272,,,fee schedule,272% of BCBS fee schedule,48.55,272,,,fee schedule,272% of BCBS fee schedule,48.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,15.72,51,
HEAVY METALS (BLOOD),17601880,CDM,301,RC,83655,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,15.13,72.25,
MYOGLOBIN SCREEN (URINE),17601906,CDM,301,RC,83874,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.83,272,,,fee schedule,272% of BCBS fee schedule,49.83,272,,,fee schedule,272% of BCBS fee schedule,49.83,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.15,49.83,
OXALATE (24HR URINE),17601930,CDM,301,RC,83945,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.72,272,,,fee schedule,272% of BCBS fee schedule,49.72,272,,,fee schedule,272% of BCBS fee schedule,49.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.06,49.72,
POTASSIUM(24 HR)URINE,17601989,CDM,301,RC,84133,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,16.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.91,17.85,
PORPHYRINE QUANT (24HR URINE),17602003,CDM,301,RC,84110,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,32.61,272,,,fee schedule,272% of BCBS fee schedule,32.61,272,,,fee schedule,272% of BCBS fee schedule,32.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32.61,
VMA (24HR URINE),17602169,CDM,301,RC,84585,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.84,272,,,fee schedule,272% of BCBS fee schedule,59.84,272,,,fee schedule,272% of BCBS fee schedule,59.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.37,59.84,
CALCIUM (24HR URINE),17602177,CDM,301,RC,82340,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,7.53,23.8,
CATECHOLOMINES (24HR URINE),17602185,CDM,301,RC,82384,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,89.54,272,,,fee schedule,272% of BCBS fee schedule,89.54,272,,,fee schedule,272% of BCBS fee schedule,89.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,89.54,
CREATININE CLEARANCE (24HR URINE,17602193,CDM,301,RC,82575,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,36.48,272,,,fee schedule,272% of BCBS fee schedule,36.48,272,,,fee schedule,272% of BCBS fee schedule,36.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.82,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,11.82,68,
KETOSTEROIDS-17 (24HR URINE),17602201,CDM,301,RC,83586,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.42,272,,,fee schedule,272% of BCBS fee schedule,49.42,272,,,fee schedule,272% of BCBS fee schedule,49.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16,49.42,
AFP-TRI MATERNAL(XTRA)SCREEN,17602219,CDM,301,RC,81512,HCPCS,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,86.9,
NEW TEST ORDER QUEST 360,17602222,CDM,301,RC,,,OUTPATIENT,,,143.00,57.20,,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.8,60,,68.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,100.1,70,,80.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,121.55,
BB ANTIBODY ID (REFERENCE),17602227,CDM,300,RC,86870,HCPCS,OUTPATIENT,,,489.00,195.60,,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.4,60,,234.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,415.65,
VITAMIN B-6 (PYRIDOXAL PHOSPHATE),17602234,CDM,302,RC,86256,HCPCS,OUTPATIENT,,,55.00,22.00,,11.16,100,,,fee schedule,100% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,11.16,46.75,
ANTI-STRAITED MUSCLE ANTIBODY,17602245,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
ANA/ANTINUCLEAR ANTIBODIES,17602250,CDM,302,RC,86038,HCPCS,OUTPATIENT,,,55.00,22.00,,11.19,100,,,fee schedule,100% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.65,272,,,fee schedule,272% of BCBS fee schedule,46.65,272,,,fee schedule,272% of BCBS fee schedule,46.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,11.19,46.75,
CHROMOSOMAL IN SITU HYBRIDIZATION ANALYZ,17602252,CDM,302,RC,88273,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
MOLECULAR CYTOGENETICS DNA PROBE,17602255,CDM,302,RC,88271,HCPCS,OUTPATIENT,,,60.00,24.00,59,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
BB BLOOD TYPE /ABO (REFERENCE),17602260,CDM,300,RC,86900,HCPCS,OUTPATIENT,,,49.60,19.84,,2.77,100,,,fee schedule,100% of Aetna fee schedule,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,11.51,272,,,fee schedule,272% of BCBS fee schedule,11.51,272,,,fee schedule,272% of BCBS fee schedule,11.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,29.76,60,,23.81,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,42.16,85,,33.73,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,34.72,70,,27.78,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,2.77,42.16,
BB RH TYPE (REFERENCE),17602261,CDM,300,RC,86901,HCPCS,OUTPATIENT,,,49.60,19.84,,2.77,100,,,fee schedule,100% of Aetna fee schedule,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,60,,23.81,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,42.16,85,,33.73,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,34.72,70,,27.78,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,15.87,32,,12.7,percent of total billed charges,32% of total billed charges,2.77,42.16,
BB SPECIAL ANTIGEN TYPING (REFERENCE),17602265,CDM,300,RC,86902,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,22.77,272,,,fee schedule,272% of BCBS fee schedule,22.77,272,,,fee schedule,272% of BCBS fee schedule,22.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,7.93,51.85,
BB BLOOD TYPE(ABO),17602268,CDM,300,RC,86900,HCPCS,OUTPATIENT,,,20.00,8.00,,2.77,100,,,fee schedule,100% of Aetna fee schedule,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,11.51,272,,,fee schedule,272% of BCBS fee schedule,11.51,272,,,fee schedule,272% of BCBS fee schedule,11.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,2.77,17,
BB ANTIBODY ELUTION (REFERENCE),17602270,CDM,300,RC,86860,HCPCS,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,150.45,
BB DAT (REFERENCE),17602280,CDM,300,RC,86880,HCPCS,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,6.73,119,
CULTURE BRONCHIAL WASHINGS),17602292,CDM,306,RC,87015,HCPCS,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,8.35,33.15,
PARIETAL CELL AB,17602295,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
BABESIA MICROTI ANTI PANEL #1,17602310,CDM,302,RC,86753,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.84,272,,,fee schedule,272% of BCBS fee schedule,47.84,272,,,fee schedule,272% of BCBS fee schedule,47.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.48,47.84,
BABESIA MICROTI ANTI PANEL #2,17602315,CDM,302,RC,86753,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.84,272,,,fee schedule,272% of BCBS fee schedule,47.84,272,,,fee schedule,272% of BCBS fee schedule,47.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.48,47.84,
BB DIRECT COOMBS (DAT),17602326,CDM,300,RC,86880,HCPCS,OUTPATIENT,,,33.97,13.59,,,,,,other ,not seperately reimbursable,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.38,60,,16.3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,28.87,85,,23.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,23.78,70,,19.02,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,10.87,32,,8.7,percent of total billed charges,32% of total billed charges,6.73,28.87,
GLUCAGON,17602333,CDM,301,RC,82943,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.16,272,,,fee schedule,272% of BCBS fee schedule,55.16,272,,,fee schedule,272% of BCBS fee schedule,55.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,17.86,55.25,
BB ANTIBODY SCREEN,17602334,CDM,300,RC,86850,HCPCS,OUTPATIENT,,,48.00,19.20,,9.77,100,,,fee schedule,100% of Aetna fee schedule,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,9.77,40.8,
BB CROSSMATCH,17602342,CDM,390,RC,86920,HCPCS,OUTPATIENT,,,290.00,116.00,,,,,,other ,not seperately reimbursable,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174,60,,139.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,203,70,,162.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,92.8,32,,74.24,percent of total billed charges,32% of total billed charges,92.8,246.5,
C 3 COMPLEMENT,17602359,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15,46.75,
C 4 COMPLEMENT,17602367,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15,46.75,
HLA B27,17602441,CDM,302,RC,86812,HCPCS,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,99.61,272,,,fee schedule,272% of BCBS fee schedule,99.61,272,,,fee schedule,272% of BCBS fee schedule,99.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,32.26,99.61,
****IMMUNOELECTROPHORESIS SERUM,17602466,CDM,300,RC,86320,HCPCS,OUTPATIENT,,,101.00,40.40,,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,86.52,272,,,fee schedule,272% of BCBS fee schedule,86.52,272,,,fee schedule,272% of BCBS fee schedule,86.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,86.52,
INDIA INK PREP,17602474,CDM,300,RC,87210,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
HYDROXYCORTICOSTERONE 18 (18OH,17602482,CDM,301,RC,82528,HCPCS,OUTPATIENT,,,101.00,40.40,,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,86.9,272,,,fee schedule,272% of BCBS fee schedule,86.9,272,,,fee schedule,272% of BCBS fee schedule,86.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,28.15,86.9,
TESTOSTERONE WOMEN/CHILDREN TOTAL,17602488,CDM,301,RC,84403,HCPCS,OUTPATIENT,,,116.00,46.40,,23.89,100,,,fee schedule,100% of Aetna fee schedule,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,99.66,272,,,fee schedule,272% of BCBS fee schedule,99.66,272,,,fee schedule,272% of BCBS fee schedule,99.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,23.89,99.66,
INHIBIN-B,17602538,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,144.00,57.60,,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,86.4,60,,69.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,21.58,122.4,
PTH-INTACT W/CALCIUM,17602540,CDM,301,RC,83970,HCPCS,OUTPATIENT,,,185.00,74.00,,38.22,100,,,fee schedule,100% of Aetna fee schedule,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,159.34,272,,,fee schedule,272% of BCBS fee schedule,159.34,272,,,fee schedule,272% of BCBS fee schedule,159.34,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,51.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,38.22,159.34,
CORTICOSTEROIDS,17602556,CDM,301,RC,83491,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,67.62,272,,,fee schedule,272% of BCBS fee schedule,67.62,272,,,fee schedule,272% of BCBS fee schedule,67.62,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,22.37,68,
HYDROXYCORTICOSTEROIDS 17 (17OH,17602557,CDM,301,RC,83491,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,67.62,272,,,fee schedule,272% of BCBS fee schedule,67.62,272,,,fee schedule,272% of BCBS fee schedule,67.62,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,22.37,68,
JAK2 MUTATION(V617F)ANALYSIS PLASMA BASE,17602558,CDM,310,RC,81270,HCPCS,OUTPATIENT,,,1347.00,538.80,,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,808.2,60,,646.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.57,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,942.9,70,,754.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,431.04,32,,344.83,percent of total billed charges,32% of total billed charges,114.57,1144.95,
INDERAL (PROPRANOLOL),17602596,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
PROCAINAMIDE,17602599,CDM,301,RC,80192,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.65,272,,,fee schedule,272% of BCBS fee schedule,64.65,272,,,fee schedule,272% of BCBS fee schedule,64.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,20.93,64.65,
RUBELLA  IGG IMMUNE STATUS,17602615,CDM,302,RC,86762,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,17.98,56.1,
CALCIUM (BODY FLUIDS),17602616,CDM,301,RC,82310,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,19.88,272,,,fee schedule,272% of BCBS fee schedule,19.88,272,,,fee schedule,272% of BCBS fee schedule,19.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,6.45,20.4,
CCP IgG AB(CYCLIC CITRULLINATED PEPTIDE),17602617,CDM,301,RC,86200,HCPCS,OUTPATIENT,,,144.00,57.60,,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,60,,69.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,16.18,122.4,
MERCURY (BLOOD),17602618,CDM,301,RC,83825,HCPCS,OUTPATIENT,,,114.40,45.76,,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,62.75,272,,,fee schedule,272% of BCBS fee schedule,62.75,272,,,fee schedule,272% of BCBS fee schedule,62.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,68.64,60,,54.91,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,97.24,85,,77.79,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,80.08,70,,64.06,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,20.32,97.24,
AMOEBA ANTIBODY,17602619,CDM,302,RC,86753,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.84,272,,,fee schedule,272% of BCBS fee schedule,47.84,272,,,fee schedule,272% of BCBS fee schedule,47.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.48,47.84,
STONE ANALYSIS (RENAL CALCULUS),17602664,CDM,300,RC,82355,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,44.66,272,,,fee schedule,272% of BCBS fee schedule,44.66,272,,,fee schedule,272% of BCBS fee schedule,44.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,14.47,45.05,
BF CELL COUNT (BODY FLUID) REFERENCE,17602666,CDM,302,RC,89051,HCPCS,OUTPATIENT,,,168.00,67.20,,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,21.27,272,,,fee schedule,272% of BCBS fee schedule,21.27,272,,,fee schedule,272% of BCBS fee schedule,21.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,100.8,60,,80.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,7,142.8,
B CELLS TOTAL COUN,17602667,CDM,302,RC,86355,HCPCS,OUTPATIENT,,,168.00,67.20,,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,60,,80.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,47.16,142.8,
CELL ABSOLUTE COUNT/RATIO,17602668,CDM,302,RC,86360,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,58.72,
TEGRETOL (CARBAMAZEPINE),17602672,CDM,301,RC,80156,HCPCS,OUTPATIENT,,,108.00,43.20,,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,56.2,272,,,fee schedule,272% of BCBS fee schedule,56.2,272,,,fee schedule,272% of BCBS fee schedule,56.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,64.8,60,,51.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,75.6,70,,60.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,18.21,91.8,
CHROMOGRANIN A,17602673,CDM,302,RC,86316,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,26.01,79.05,
CULTURE CMV (BLOOD),17602771,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.64,272,,,fee schedule,272% of BCBS fee schedule,100.64,272,,,fee schedule,272% of BCBS fee schedule,100.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,32.58,100.64,
G6PD/GLU 6 PHOSPHATE DEHYDROGENASE,17602797,CDM,301,RC,82955,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,37.43,272,,,fee schedule,272% of BCBS fee schedule,37.43,272,,,fee schedule,272% of BCBS fee schedule,37.43,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,12.12,38.25,
SODIUM URINE (24HR),17602854,CDM,301,RC,84300,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.77,272,,,fee schedule,272% of BCBS fee schedule,18.77,272,,,fee schedule,272% of BCBS fee schedule,18.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,6.32,50.15,
URIC ACID,17602870,CDM,301,RC,84550,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,17.44,272,,,fee schedule,272% of BCBS fee schedule,17.44,272,,,fee schedule,272% of BCBS fee schedule,17.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,5.65,31.45,
LDH ISOENZYMES,17602888,CDM,301,RC,83625,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.4,272,,,fee schedule,272% of BCBS fee schedule,49.4,272,,,fee schedule,272% of BCBS fee schedule,49.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,15.98,49.4,
GLUCOSE (RANDOM),17602904,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.15,272,,,fee schedule,272% of BCBS fee schedule,15.15,272,,,fee schedule,272% of BCBS fee schedule,15.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.91,18.7,
CORTISOL FREE (24 HR URINE),17602953,CDM,301,RC,82530,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.52,272,,,fee schedule,272% of BCBS fee schedule,64.52,272,,,fee schedule,272% of BCBS fee schedule,64.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,20.88,64.6,
FACTOR X (STUART POWER),17602975,CDM,305,RC,85260,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,22.37,69.12,
PYRUVIC ACID(PYRUVATE) BLOOD,17602976,CDM,301,RC,84210,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,41.92,272,,,fee schedule,272% of BCBS fee schedule,41.92,272,,,fee schedule,272% of BCBS fee schedule,41.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
BF CHLORIDE (BODY FLUID),17602995,CDM,301,RC,82438,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.25,19.55,
CALCIUM (RANDOM URINE),17603009,CDM,301,RC,82310,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.88,272,,,fee schedule,272% of BCBS fee schedule,19.88,272,,,fee schedule,272% of BCBS fee schedule,19.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,6.45,23.8,
CRP (C-REACTIVE PROTEIN),17603027,CDM,302,RC,86140,HCPCS,OUTPATIENT,,,78.00,31.20,,4.79,100,,,fee schedule,100% of Aetna fee schedule,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,4.79,66.3,
CULTURE GROUP B STREP MATERNAL SCREEN,17603028,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,8.28,27.2,
MECONIUM DRUG ANALYSIS,17603029,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
DNA ANTIBODY CRITHIDIA(C360),17603031,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
ID & SENSI POS BLOOD CULT,17603068,CDM,306,RC,87186,HCPCS,OUTPATIENT,,,40.00,16.00,,8,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.37,272,,,fee schedule,272% of BCBS fee schedule,33.37,272,,,fee schedule,272% of BCBS fee schedule,33.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,8,34,
PROTEIN TOTAL,17603092,CDM,301,RC,84155,HCPCS,OUTPATIENT,,,20.83,8.33,,,,,,other ,not seperately reimbursable,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,14.14,272,,,fee schedule,272% of BCBS fee schedule,14.14,272,,,fee schedule,272% of BCBS fee schedule,14.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.5,60,,10,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,17.71,85,,14.17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,14.58,70,,11.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,6.67,32,,5.34,percent of total billed charges,32% of total billed charges,4.58,17.71,
PORPHYRINES-QUAL (RANDOM URINE),17603164,CDM,301,RC,84120,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.79,272,,,fee schedule,272% of BCBS fee schedule,56.79,272,,,fee schedule,272% of BCBS fee schedule,56.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,18.38,56.95,
CATECHOLAMINES (PLASMA),17603175,CDM,301,RC,82383,HCPCS,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.75,272,,,fee schedule,272% of BCBS fee schedule,96.75,272,,,fee schedule,272% of BCBS fee schedule,96.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,96.75,
GASTRIN,17603191,CDM,301,RC,82941,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68.08,272,,,fee schedule,272% of BCBS fee schedule,68.08,272,,,fee schedule,272% of BCBS fee schedule,68.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,22.03,68.08,
CARDIOLIPIN ANTIBODIES,17603216,CDM,302,RC,86147,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,62.21,272,,,fee schedule,272% of BCBS fee schedule,62.21,272,,,fee schedule,272% of BCBS fee schedule,62.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
ARSENIC (BLOOD),17603217,CDM,301,RC,82175,HCPCS,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,73.25,272,,,fee schedule,272% of BCBS fee schedule,73.25,272,,,fee schedule,272% of BCBS fee schedule,73.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,23.71,115.6,
ZO NOT USE            2,17603225,CDM,301,RC,82785,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,63.59,272,,,fee schedule,272% of BCBS fee schedule,63.59,272,,,fee schedule,272% of BCBS fee schedule,63.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.57,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,63.59,
.INSULIN-TOTAL (FREE & BOUND),17603258,CDM,301,RC,83525,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.15,272,,,fee schedule,272% of BCBS fee schedule,44.15,272,,,fee schedule,272% of BCBS fee schedule,44.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,14.28,44.2,
.SMOOTH MUSCLE ANTIBODY,17603259,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,15.06,94.35,
FSH (24HR URINE),17603274,CDM,301,RC,83001,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.75,272,,,fee schedule,272% of BCBS fee schedule,71.75,272,,,fee schedule,272% of BCBS fee schedule,71.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,23.22,71.75,
.REFLEX FREE T4,17603280,CDM,301,RC,84439,HCPCS,OUTPATIENT,,,68.00,27.20,,8.35,100,,,fee schedule,100% of Aetna fee schedule,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,8.35,57.8,
T4 FREE,17603289,CDM,301,RC,84439,HCPCS,OUTPATIENT,,,98.28,39.31,,8.35,100,,,fee schedule,100% of Aetna fee schedule,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,58.97,60,,47.18,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,83.54,85,,66.83,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,68.8,70,,55.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,31.45,32,,25.16,percent of total billed charges,32% of total billed charges,8.35,83.54,
CAMPYLOBACTER (STOOL),17603308,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,11.8,36.55,
ORGANIC ACID QUANT (URINE),17603345,CDM,301,RC,83918,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
FLUNITRAZEPAM (RUFFIES) URINE,17603349,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
VIRAL LOAD (HIV-1/QUANTIFICATION),17603358,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
FSH,17603373,CDM,301,RC,83001,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.75,272,,,fee schedule,272% of BCBS fee schedule,71.75,272,,,fee schedule,272% of BCBS fee schedule,71.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,23.22,71.75,
BRUCELLA ABORTUS AGGLUTININS,17603381,CDM,302,RC,86622,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,34.49,272,,,fee schedule,272% of BCBS fee schedule,34.49,272,,,fee schedule,272% of BCBS fee schedule,34.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,34.49,
AFP-TUMOR MARKER,17603397,CDM,301,RC,82105,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.76,272,,,fee schedule,272% of BCBS fee schedule,64.76,272,,,fee schedule,272% of BCBS fee schedule,64.76,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,20.96,64.76,
TESTOSTERONE TOTAL(MALE),17603407,CDM,301,RC,84403,HCPCS,OUTPATIENT,,,116.00,46.40,,23.89,100,,,fee schedule,100% of Aetna fee schedule,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,99.66,272,,,fee schedule,272% of BCBS fee schedule,99.66,272,,,fee schedule,272% of BCBS fee schedule,99.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,23.89,99.66,
PL-7 AUTOANTIBODIES,17603516,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,22.41,73.1,
IGF-1(SOMATOMEDIN C)INSULIN GROWTH FAC-1,17603519,CDM,301,RC,84305,HCPCS,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,74.12,272,,,fee schedule,272% of BCBS fee schedule,74.12,272,,,fee schedule,272% of BCBS fee schedule,74.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.57,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,26.57,75.65,
PSA(DIAGNOSTIC),17603548,CDM,301,RC,84153,HCPCS,OUTPATIENT,,,107.00,42.80,,17.03,100,,,fee schedule,100% of Aetna fee schedule,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,71.02,272,,,fee schedule,272% of BCBS fee schedule,71.02,272,,,fee schedule,272% of BCBS fee schedule,71.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,17.03,90.95,
PSA(SCREENING),17603550,CDM,301,RC,G0103,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,24.13,90.95,
PHLEBOTOMY METAMETRIX,17603555,CDM,300,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SULFONYLUREA HYPOGLYCEMICS SCREEN,17603567,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
VON WILLIBRAND MULTIMETRIC,17603568,CDM,305,RC,85247,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,28.67,88.59,
RISTOCETIN CO-FACTOR,17603569,CDM,305,RC,85245,HCPCS,OUTPATIENT,,,148.00,59.20,,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,88.8,60,,71.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,103.6,70,,82.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,28.67,125.8,
PHLEBOTOMY QUEST,17603570,CDM,300,RC,36415,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,3.75,16.15,
PHLEBOTOMY,17603571,CDM,300,RC,36415,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,3.75,16.15,
CANDIDA ANTIGEN DETECTOR,17603572,CDM,302,RC,86403,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,14.42,40.8,
PHLEBOTOMY QUEST ADD'L DRAW,17603573,CDM,300,RC,36415,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,8.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,3.75,12.75,
"ACTH, PLASMA",17603578,CDM,301,RC,82024,HCPCS,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,149.14,272,,,fee schedule,272% of BCBS fee schedule,149.14,272,,,fee schedule,272% of BCBS fee schedule,149.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,48.27,149.14,
AMINO ACID SCREEN-QUAL (PLASMA),17603579,CDM,301,RC,82128,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,17.33,54.4,
AMINO ACID SCREEN-QUAL (URINE),17603580,CDM,301,RC,82128,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,17.33,54.4,
.CANNABINOID (URINE),17603589,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
.COCAINE (URINE),17603597,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
IMMUNOFIXATION (URINE),17603598,CDM,302,RC,86335,HCPCS,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,36.68,102,
PERTUSSIS CULTURE,17603599,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
IMMUNOFIXATION (CSF),17603600,CDM,302,RC,86334,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,86.25,272,,,fee schedule,272% of BCBS fee schedule,86.25,272,,,fee schedule,272% of BCBS fee schedule,86.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,27.92,86.25,
BETA HCG URINE (QUALITATIVE),17603605,CDM,301,RC,81025,HCPCS,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,24.43,272,,,fee schedule,272% of BCBS fee schedule,24.43,272,,,fee schedule,272% of BCBS fee schedule,24.43,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,10.76,39.95,
BETA HCG SERUM (QUALITATIVE),17603606,CDM,301,RC,84703,HCPCS,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,29,272,,,fee schedule,272% of BCBS fee schedule,29,272,,,fee schedule,272% of BCBS fee schedule,29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,9.4,39.95,
DIPHTHERIA(C360),17603609,CDM,302,RC,86648,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,58.7,272,,,fee schedule,272% of BCBS fee schedule,58.7,272,,,fee schedule,272% of BCBS fee schedule,58.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.01,59.5,
DOXEPIN(C360),17603610,CDM,301,RC,80166,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
BETA HCG (QUANTITATIVE),17603613,CDM,301,RC,84702,HCPCS,OUTPATIENT,,,88.00,35.20,,13.94,100,,,fee schedule,100% of Aetna fee schedule,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,13.94,74.8,
"BCR/ABL GENE REARRRANGEMENT, QUANT PCR",17603614,CDM,310,RC,81206,HCPCS,OUTPATIENT,,,660.00,264.00,,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,60,,316.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,204.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,561,85,,448.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,462,70,,369.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,204.95,561,
"bcr/abl Gene Rearrange, Quant PCR #1",17603615,CDM,302,RC,83896,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
"bcr/abl Gene Rearrange, Quant PCR #2",17603616,CDM,310,RC,83912,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
"bcr/abl Gene Rearrange, Quant PCR #3",17603617,CDM,302,RC,83891,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
"bcr/abl Gene Rearrange, Quant PCR #4",17603618,CDM,302,RC,83898,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
"bcr/abl Gene Rearrange, Quant PCR #5",17603619,CDM,302,RC,83901,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
"bcr/abl Gene Rearrange, Quant PCR #6",17603620,CDM,302,RC,83902,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,55.25,
GLOBULIN TOTAL,17603621,CDM,301,RC,82040,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.42,272,,,fee schedule,272% of BCBS fee schedule,15.42,272,,,fee schedule,272% of BCBS fee schedule,15.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,6.18,18.7,
"Nucleic acid, high resolute",17603622,CDM,302,RC,83909,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
CMV DNA PCR QUANT,17603623,CDM,306,RC,87497,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,53.55,163.2,
DIBUCAINE,17603624,CDM,301,RC,82638,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.27,272,,,fee schedule,272% of BCBS fee schedule,47.27,272,,,fee schedule,272% of BCBS fee schedule,47.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.31,47.6,
"B-CELL Gene Rearrangement, Qual, PCR",17603625,CDM,310,RC,81261,HCPCS,OUTPATIENT,,,603.00,241.20,,,,,,other ,not seperately reimbursable,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361.8,60,,289.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,247.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,422.1,70,,337.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,192.96,32,,154.37,percent of total billed charges,32% of total billed charges,192.96,512.55,
T-CELL RECEPTOR Gene Rearrange,17603626,CDM,310,RC,81402,HCPCS,OUTPATIENT,,,882.00,352.80,,,,,,other ,not seperately reimbursable,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,529.2,60,,423.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,187.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,749.7,85,,599.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,617.4,70,,493.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,282.24,32,,225.79,percent of total billed charges,32% of total billed charges,187.91,749.7,
CRP CARDIO(HIGH SENSITIVITY),17603627,CDM,302,RC,86141,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.18,49.3,
TISSUE(IgA)TRANSGLUTAMINASE (tTG),17603628,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
MYSOLINE (PRIMIDONE),17603647,CDM,301,RC,80188,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.29,272,,,fee schedule,272% of BCBS fee schedule,63.29,272,,,fee schedule,272% of BCBS fee schedule,63.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,20.73,63.75,
DIBUCAINE #2,17603648,CDM,301,RC,82480,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,26.71,272,,,fee schedule,272% of BCBS fee schedule,26.71,272,,,fee schedule,272% of BCBS fee schedule,26.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,9.83,28.9,
CBC W/DIFF,17603696,CDM,305,RC,85025,HCPCS,OUTPATIENT,,,63.00,25.20,,7.19,100,,,fee schedule,100% of Aetna fee schedule,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,30.03,272,,,fee schedule,272% of BCBS fee schedule,30.03,272,,,fee schedule,272% of BCBS fee schedule,30.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,7.19,53.55,
BB RH TYPE,17603720,CDM,300,RC,86901,HCPCS,OUTPATIENT,,,28.80,11.52,,2.77,100,,,fee schedule,100% of Aetna fee schedule,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,60,,13.82,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,24.48,85,,19.58,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,20.16,70,,16.13,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,9.22,32,,7.38,percent of total billed charges,32% of total billed charges,2.77,24.48,
REDUCING SUBSTANCES (STOOL),17603800,CDM,301,RC,84376,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,20.7,272,,,fee schedule,272% of BCBS fee schedule,20.7,272,,,fee schedule,272% of BCBS fee schedule,20.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.87,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,6.87,77.35,
TESTOSTERONE-FREE AND TOTAL,17603801,CDM,301,RC,84402,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,31.83,98.3,
ANDROSTENEDIONE,17603802,CDM,301,RC,82157,HCPCS,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,113.02,272,,,fee schedule,272% of BCBS fee schedule,113.02,272,,,fee schedule,272% of BCBS fee schedule,113.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,36.6,113.02,
AMINO ACID QUANT (URINE),17603804,CDM,301,RC,82139,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,18.2,54.4,
AMINO ACID  QUANT (PLASMA),17603805,CDM,301,RC,82139,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,18.2,54.4,
CYCLOSPORINE,17603806,CDM,301,RC,80158,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,22.56,67.15,
FECAL REDUCING SUBS,17603807,CDM,301,RC,84376,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,20.7,272,,,fee schedule,272% of BCBS fee schedule,20.7,272,,,fee schedule,272% of BCBS fee schedule,20.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.87,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,20.7,
C 1 ESTERASE INHIBITOR ACTIVITY,17603808,CDM,302,RC,86161,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15,46.75,
C 2 COMPLEMENT,17603809,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15,46.75,
PAP SMEAR (1SLIDE),17603810,CDM,311,RC,88150,HCPCS,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
PAP SMEAR (2SLIDE),17603811,CDM,311,RC,88150,HCPCS,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
ANGIOTENSIN CONVERT ENZYME (ACE),17603812,CDM,301,RC,82164,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.36,272,,,fee schedule,272% of BCBS fee schedule,56.36,272,,,fee schedule,272% of BCBS fee schedule,56.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,18.25,56.95,
GROWTH HORMONE,17603813,CDM,301,RC,83003,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.36,272,,,fee schedule,272% of BCBS fee schedule,64.36,272,,,fee schedule,272% of BCBS fee schedule,64.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,20.83,64.6,
RIBOSOMAL P ANTIBODY,17603814,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
CENTROMERE B ANTIBODY,17603815,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,69.22,
VON WILLEBRAND DIEASE PROFILE,17603818,CDM,305,RC,,,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
JO-1 AUTOANTIBODIES,17603820,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,22.41,96.05,
.STAGE II,17603821,CDM,302,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
CORTISOL PM,17603822,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,20.37,62.94,
"CYCLOSPORINE A TROUGH, BLOOD(8812)",17603823,CDM,301,RC,80158,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,22.56,67.15,
GRAM STAIN (REFERENCE)* NO SPUTUM,17603824,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
IGG-SUBCLASS 1,17603825,CDM,301,RC,82787,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,46.84,
"INSULIN, FREE",17603826,CDM,301,RC,83527,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.18,49.99,
a PTT (reference),17603827,CDM,305,RC,85730,HCPCS,OUTPATIENT,,,28.00,11.20,,5.57,100,,,fee schedule,100% of Aetna fee schedule,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.17,272,,,fee schedule,272% of BCBS fee schedule,23.17,272,,,fee schedule,272% of BCBS fee schedule,23.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,5.57,23.8,
"M. AVIUM COMPLEX, MIC PANEL",17603828,CDM,306,RC,87186,HCPCS,OUTPATIENT,,,40.00,16.00,,8,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.37,272,,,fee schedule,272% of BCBS fee schedule,33.37,272,,,fee schedule,272% of BCBS fee schedule,33.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,8,34,
FASTIDIOUS PATHOGEN MIC,17603829,CDM,306,RC,87186,HCPCS,OUTPATIENT,,,40.00,16.00,,8,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.37,272,,,fee schedule,272% of BCBS fee schedule,33.37,272,,,fee schedule,272% of BCBS fee schedule,33.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,8,34,
FREE KAPPA LIGHT & LAMBA (URINE),17603830,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17,53.55,
YEAST ID,17603831,CDM,306,RC,87106,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,12.9,39.85,
FUNGAL ID  ONLY,17603832,CDM,306,RC,87107,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,12.9,35.7,
CANDIDA ALBICANS ANTIBOD AB(IgG IgA IgM),17603835,CDM,302,RC,86628,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,30.44,272,,,fee schedule,272% of BCBS fee schedule,30.44,272,,,fee schedule,272% of BCBS fee schedule,30.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,30.44,
CANDIDA ALBICAN ANTIB AB(IgG IgA IgM)#2,17603836,CDM,302,RC,86628,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,30.44,272,,,fee schedule,272% of BCBS fee schedule,30.44,272,,,fee schedule,272% of BCBS fee schedule,30.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,30.44,
CANDIDA ALBICANS ANTIB AB(IgG IgA IgM)#3,17603837,CDM,302,RC,86628,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,30.44,272,,,fee schedule,272% of BCBS fee schedule,30.44,272,,,fee schedule,272% of BCBS fee schedule,30.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,30.44,
"FREE KAPPA /LAMBDA CHAIN,FREE, SERUM",17603840,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,17,102,
KAPPA LIGHTCHAIN FREE SERUM,17603850,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,17,102,
LAMBDA LIGHT CHAIN FREE SERUM,17603860,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,17,102,
FLECAINIDE,17603890,CDM,301,RC,80181,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,23.3,64.6,
ANCA SCREEN W/MPO/PR3 WITH REFLEX TO,17603891,CDM,301,RC,86021,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,57.64,
5-NUCLEOTIDASE,17603899,CDM,301,RC,83915,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.06,272,,,fee schedule,272% of BCBS fee schedule,43.06,272,,,fee schedule,272% of BCBS fee schedule,43.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,13.93,43.35,
"FENTANYL (Pain Management, Quant)",17603925,CDM,301,RC,83925,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
MACROPROLACTIN #1,17604146,CDM,301,RC,84146,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,24.22,74.8,
GLYCOMARK,17604378,CDM,301,RC,84378,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,30.06,272,,,fee schedule,272% of BCBS fee schedule,30.06,272,,,fee schedule,272% of BCBS fee schedule,30.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,14.41,49.3,
LOW MOLECULAR WEIGHT HEPARIN LEVEL,17604525,CDM,305,RC,85520,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,35.66,
PANCREATIC POLYPEPTIDE,17604527,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
****PROTEIN ELECTROPHORESIS UA (RANDOM),17604574,CDM,305,RC,84165,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.42,42.5,
PRE-ALBUMIN (TRANSTHYRETIN),17604578,CDM,301,RC,84134,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,56.3,272,,,fee schedule,272% of BCBS fee schedule,56.3,272,,,fee schedule,272% of BCBS fee schedule,56.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,18.23,90.1,
THYROGLOBULIN W/O THYROGLOBULIN AB,17604599,CDM,301,RC,84432,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,62.02,272,,,fee schedule,272% of BCBS fee schedule,62.02,272,,,fee schedule,272% of BCBS fee schedule,62.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,20.07,62.02,
MONO SCREEN (IN-HOUSE),17604993,CDM,302,RC,86308,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,6.47,30.6,
TISSUE GROSS AND MICRO,17605022,CDM,310,RC,88305,HCPCS,OUTPATIENT,,,313.00,125.20,,62.08,100,,,fee schedule,100% of Aetna fee schedule,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,242.08,272,,,fee schedule,272% of BCBS fee schedule,242.08,272,,,fee schedule,272% of BCBS fee schedule,242.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,187.8,60,,150.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,219.1,70,,175.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,40.83,266.05,
TISSUE FROZEN SECTION,17605030,CDM,310,RC,88331,HCPCS,OUTPATIENT,,,281.00,112.40,,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.6,60,,134.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,196.7,70,,157.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,89.92,32,,71.94,percent of total billed charges,32% of total billed charges,48.95,238.85,
TISSUE SPECIAL STAIN,17605048,CDM,310,RC,88312,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,103.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,200.6,
CYTOLOGY,17605063,CDM,310,RC,88104,HCPCS,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,48.14,141.95,
PROTEIN TOTAL(URINE) IN-HOUSE,17605065,CDM,301,RC,84156,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,4.58,34.85,
PROTEIN S - ACTIVITY,17605071,CDM,305,RC,85306,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,59.16,272,,,fee schedule,272% of BCBS fee schedule,59.16,272,,,fee schedule,272% of BCBS fee schedule,59.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,19.15,59.16,
PROTEIN S ACTIVITY W/REFLEX TO P-ANTIGEN,17605073,CDM,305,RC,85306,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,59.16,272,,,fee schedule,272% of BCBS fee schedule,59.16,272,,,fee schedule,272% of BCBS fee schedule,59.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,19.15,59.16,
CSF PROTEIN TOTAL,17605080,CDM,301,RC,84157,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,5,16.15,
BONE MARROW BIOPSY,17605089,CDM,310,RC,88305,HCPCS,OUTPATIENT,,,313.00,125.20,,62.08,100,,,fee schedule,100% of Aetna fee schedule,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,242.08,272,,,fee schedule,272% of BCBS fee schedule,242.08,272,,,fee schedule,272% of BCBS fee schedule,242.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,187.8,60,,150.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,219.1,70,,175.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,40.83,266.05,
.HERPES SIMPLEX VIRUS 1gm ANTIBODIES,17605091,CDM,302,RC,86694,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,17.98,55.57,
BK VIRUS DNA QNT PCR,17605095,CDM,306,RC,87799,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,53.55,163.2,
BONE MARROW INTERPRETATION,17605097,CDM,310,RC,88307,HCPCS,OUTPATIENT,,,484.00,193.60,,147.6,100,,,fee schedule,100% of Aetna fee schedule,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,111.52,272,,,fee schedule,272% of BCBS fee schedule,111.52,272,,,fee schedule,272% of BCBS fee schedule,111.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,245.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,111.52,411.4,
PORPHOBILINOGEN 24HR URINE QUA,17605098,CDM,301,RC,84110,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,32.61,272,,,fee schedule,272% of BCBS fee schedule,32.61,272,,,fee schedule,272% of BCBS fee schedule,32.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,10.55,45.9,
GASTRIC PARIETAL CELL ANTIBDY ELISA,17605099,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
GM1 GANGLIOSIDE ANTIBODIES,17605124,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.99,
PHENOBARBITAL(REFERENCE),17605212,CDM,301,RC,80184,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,44.23,272,,,fee schedule,272% of BCBS fee schedule,44.23,272,,,fee schedule,272% of BCBS fee schedule,44.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,19.12,68.85,
DILANTIN (PHENYTOIN),17605220,CDM,301,RC,80185,HCPCS,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,51.19,272,,,fee schedule,272% of BCBS fee schedule,51.19,272,,,fee schedule,272% of BCBS fee schedule,51.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,16.56,79.9,
AABRITRIL/TIAGABINE,17605221,CDM,301,RC,80199,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
AMIKACIN PEAK,17605222,CDM,301,RC,80150,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.85,58.18,
AMIKACIN THOUGH,17605223,CDM,301,RC,80150,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.85,58.18,
TIAGABINE,17605224,CDM,301,RC,80199,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
INTRINSIC FACTOR BLOCKING ANTIBODY.,17605225,CDM,302,RC,86340,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.85,58.18,
TRYPSIN QUALITATIVE (STOOL),17605229,CDM,301,RC,84488,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,26.93,272,,,fee schedule,272% of BCBS fee schedule,26.93,272,,,fee schedule,272% of BCBS fee schedule,26.93,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,9.12,28.9,
THEOPHYLLINE,17605238,CDM,301,RC,80198,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,54.64,272,,,fee schedule,272% of BCBS fee schedule,54.64,272,,,fee schedule,272% of BCBS fee schedule,54.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,17.67,74.8,
GLUCOSE (BEDSIDE),17605239,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,12.21,272,,,fee schedule,272% of BCBS fee schedule,12.21,272,,,fee schedule,272% of BCBS fee schedule,12.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,6.3,43.35,
CATECHOLOMINES (RANDOM URINE),17605244,CDM,301,RC,82384,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,89.54,272,,,fee schedule,272% of BCBS fee schedule,89.54,272,,,fee schedule,272% of BCBS fee schedule,89.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,31.56,89.54,
VON WILLEBRAND FACTOR ACTIVITY,17605245,CDM,305,RC,85245,HCPCS,OUTPATIENT,,,148.00,59.20,,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,88.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,88.8,60,,71.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,103.6,70,,82.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,47.36,32,,37.89,percent of total billed charges,32% of total billed charges,28.67,125.8,
DIGOXIN(LANOXIN),17605246,CDM,300,RC,80162,HCPCS,OUTPATIENT,,,92.00,36.80,,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,51.27,272,,,fee schedule,272% of BCBS fee schedule,51.27,272,,,fee schedule,272% of BCBS fee schedule,51.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,55.2,60,,44.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,64.4,70,,51.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,16.6,78.2,
INFLUENZA A & B CULTURE #1,17605248,CDM,306,RC,87254,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,24.45,73.95,
INFLUENZA A & B CULTURE #2,17605249,CDM,306,RC,87254,HCPCS,OUTPATIENT,,,87.00,34.80,59,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,24.45,73.95,
ELASTASE(CARE360),17605250,CDM,301,RC,82656,HCPCS,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,14.41,204,
HIV 1&2 AG/AB (4TH GEN),17605261,CDM,302,RC,87389,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
RAPID STREP,17605279,CDM,302,RC,87880,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
ALLOPURINOL,17605299,CDM,301,RC,80375,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,62.91,272,,,fee schedule,272% of BCBS fee schedule,62.91,272,,,fee schedule,272% of BCBS fee schedule,62.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,62.91,
KU AUTOANTIBODIES,17605316,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,14.41,44.55,
RSV (RESPIRATORY SYNCYTIAL VIRUS),17605321,CDM,302,RC,87804,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
BACTERIAL ANTIGENS (SERUM),17605322,CDM,302,RC,83518,HCPCS,OUTPATIENT,,,201.00,80.40,,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,32.75,272,,,fee schedule,272% of BCBS fee schedule,32.75,272,,,fee schedule,272% of BCBS fee schedule,32.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,120.6,60,,96.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,12.05,170.85,
BACTERIAL ANTIGENS (CSF),17605323,CDM,302,RC,83518,HCPCS,OUTPATIENT,,,201.00,80.40,,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,32.75,272,,,fee schedule,272% of BCBS fee schedule,32.75,272,,,fee schedule,272% of BCBS fee schedule,32.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,120.6,60,,96.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,12.05,170.85,
CYANIDE,17605332,CDM,301,RC,82600,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,74.88,272,,,fee schedule,272% of BCBS fee schedule,74.88,272,,,fee schedule,272% of BCBS fee schedule,74.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,24.25,74.88,
TOPAMEX (TOPIRAMATE),17605333,CDM,301,RC,80201,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.9,45.9,
BILIRUBIN DIRECT,17605337,CDM,301,RC,82248,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,6.27,22.95,
PHLEBOTOMY(THERAPEUTIC),17605345,CDM,940,RC,99195,HCPCS,OUTPATIENT,,,142.00,56.80,,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.2,60,,68.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,123.76,
BB EMERGENCY DELIVERY FEE,17605352,CDM,279,RC,,,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,82.45,
CARNITINE,17605364,CDM,301,RC,82379,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,18.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
CHOLESTEROL (BODY FLUID),17605366,CDM,301,RC,84311,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,27.01,
BETA 2 MICROGLOBIN,17605369,CDM,301,RC,82232,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,62.48,272,,,fee schedule,272% of BCBS fee schedule,62.48,272,,,fee schedule,272% of BCBS fee schedule,62.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,20.22,62.48,
LDH(BODY FLUID),17605389,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,28.00,11.20,,5.59,100,,,fee schedule,100% of Aetna fee schedule,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,5.59,23.8,
N TELOPEPTIDE(NTx)BY ELISA 29747,17605397,CDM,301,RC,82523,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,23.35,71.4,
CLOMIPRAMINE (ANAFRANIL),17605413,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
MUMPS IgG ANTIBODY,17605415,CDM,302,RC,86735,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,50.37,272,,,fee schedule,272% of BCBS fee schedule,50.37,272,,,fee schedule,272% of BCBS fee schedule,50.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.31,51,
MUMPS IgM ANTIBODY,17605416,CDM,302,RC,86735,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,50.37,272,,,fee schedule,272% of BCBS fee schedule,50.37,272,,,fee schedule,272% of BCBS fee schedule,50.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.31,51,
****RUBELLA TITER - TOTAL ANTIBODY,17605417,CDM,302,RC,86762,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,17.98,56.1,
RUBEOLA (IGG IGM),17605418,CDM,302,RC,86765,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
DILANTIN FREE (REFERENCE),17605423,CDM,301,RC,80186,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.15,272,,,fee schedule,272% of BCBS fee schedule,53.15,272,,,fee schedule,272% of BCBS fee schedule,53.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17.2,53.55,
HEP Be ANTIBODY,17605436,CDM,302,RC,86707,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,43.47,272,,,fee schedule,272% of BCBS fee schedule,43.47,272,,,fee schedule,272% of BCBS fee schedule,43.47,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,14.46,45.05,
***HEP B SURF AB(VACCINE SC,17605437,CDM,302,RC,86707,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,43.47,272,,,fee schedule,272% of BCBS fee schedule,43.47,272,,,fee schedule,272% of BCBS fee schedule,43.47,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,14.46,45.05,
HAEMOPHILUS INFLUENZA TYPE B AB IGG,17605438,CDM,302,RC,86684,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,61.17,272,,,fee schedule,272% of BCBS fee schedule,61.17,272,,,fee schedule,272% of BCBS fee schedule,61.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,19.8,61.17,
SOMATOSTATIN,17605439,CDM,301,RC,84307,HCPCS,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,58.13,272,,,fee schedule,272% of BCBS fee schedule,58.13,272,,,fee schedule,272% of BCBS fee schedule,58.13,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,22.85,92.65,
BMP (BASIC METABOLIC PANEL),17605463,CDM,301,RC,80048,HCPCS,OUTPATIENT,,,70.00,28.00,,7.83,100,,,fee schedule,100% of Aetna fee schedule,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,31.82,272,,,fee schedule,272% of BCBS fee schedule,31.82,272,,,fee schedule,272% of BCBS fee schedule,31.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.57,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,7.83,59.5,
ELECTROLYTE PANEL,17605464,CDM,301,RC,80051,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,26.36,272,,,fee schedule,272% of BCBS fee schedule,26.36,272,,,fee schedule,272% of BCBS fee schedule,26.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,8.76,45.9,
CMP (COMPREHENSIVE METABOLIC PANEL),17605465,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,120.00,48.00,,9.78,100,,,fee schedule,100% of Aetna fee schedule,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,39.74,272,,,fee schedule,272% of BCBS fee schedule,39.74,272,,,fee schedule,272% of BCBS fee schedule,39.74,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,9.78,102,
HEPATIC (LIVER) FUNCTION PANEL,17605466,CDM,301,RC,80076,HCPCS,OUTPATIENT,,,70.00,28.00,,7.57,100,,,fee schedule,100% of Aetna fee schedule,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,30.71,272,,,fee schedule,272% of BCBS fee schedule,30.71,272,,,fee schedule,272% of BCBS fee schedule,30.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,7.57,59.5,
"HEP A,B,C DIAG PANEL",17605467,CDM,301,RC,80074,HCPCS,OUTPATIENT,,,212.00,84.80,,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,127.2,60,,101.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,59.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,148.4,70,,118.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,59.53,180.2,
LIPID PANEL,17605468,CDM,301,RC,80061,HCPCS,OUTPATIENT,,,105.00,42.00,,9.83,100,,,fee schedule,100% of Aetna fee schedule,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,51.71,272,,,fee schedule,272% of BCBS fee schedule,51.71,272,,,fee schedule,272% of BCBS fee schedule,51.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,9.83,89.25,
ZO NOT USE,17605469,CDM,305,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
TORCH PANEL - IGM ANTIBODIES,17605470,CDM,302,RC,86778,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.6,272,,,fee schedule,272% of BCBS fee schedule,55.6,272,,,fee schedule,272% of BCBS fee schedule,55.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,18.01,56.1,
TROPONIN-I,17605473,CDM,301,RC,84484,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,15.58,77.35,
TRANSFUSION REACTION WORK-UP,17605477,CDM,310,RC,86078,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32.5,
METHYLMALONIC ACID,17605478,CDM,301,RC,83918,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
MAG ANTIBODIES,17605489,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.99,
QUANTIFERON TB GOLD,17605490,CDM,302,RC,86480,HCPCS,OUTPATIENT,,,246.00,98.40,,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.6,60,,118.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,172.2,70,,137.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,77.47,209.1,
COPPER BLOOD,17605492,CDM,301,RC,82525,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.51,47.93,
COPPER SERUM,17605493,CDM,301,RC,82525,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,47.93,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.51,47.93,
HOMOCYSTEINE,17605497,CDM,301,RC,83090,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,22.4,64.6,
TRICYCLICS (URINE),17605498,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
CRYPTOCOCCAL AB,17605513,CDM,302,RC,86403,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,14.42,44.2,
MENINGITIS ANTIGEN,17605514,CDM,306,RC,87449,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,45.1,272,,,fee schedule,272% of BCBS fee schedule,45.1,272,,,fee schedule,272% of BCBS fee schedule,45.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,14.97,46.75,
LAMOTRIGINE (LAMICTAL),17605524,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
ENDOMETRIAL SMEAR,17605531,CDM,311,RC,88304,HCPCS,OUTPATIENT,,,140.00,56.00,,36.86,100,,,fee schedule,100% of Aetna fee schedule,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,46.24,272,,,fee schedule,272% of BCBS fee schedule,46.24,272,,,fee schedule,272% of BCBS fee schedule,46.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,36.36,119,
CITRATE (24HR URINE),17605532,CDM,301,RC,82507,HCPCS,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,107.36,272,,,fee schedule,272% of BCBS fee schedule,107.36,272,,,fee schedule,272% of BCBS fee schedule,107.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,34.75,107.36,
.ANTI SCLERODERMA 70 AB,17605534,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
BMP W/GFR,17605537,CDM,301,RC,80048,HCPCS,OUTPATIENT,,,70.00,28.00,,7.83,100,,,fee schedule,100% of Aetna fee schedule,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,31.82,272,,,fee schedule,272% of BCBS fee schedule,31.82,272,,,fee schedule,272% of BCBS fee schedule,31.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.57,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,7.83,59.5,
CRYPTOCOCCAL AG (CSF)C360,17605543,CDM,302,RC,86403,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,14.42,40.8,
DEOXYCORTISOL 11,17605548,CDM,301,RC,82633,HCPCS,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119.6,272,,,fee schedule,272% of BCBS fee schedule,119.6,272,,,fee schedule,272% of BCBS fee schedule,119.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,38.72,119.6,
DEOXYCORTICOSTERONE,17605550,CDM,301,RC,82633,HCPCS,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119.6,272,,,fee schedule,272% of BCBS fee schedule,119.6,272,,,fee schedule,272% of BCBS fee schedule,119.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,38.72,119.6,
ANTI PM1 AB,17605556,CDM,302,RC,86331,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,14.97,46.75,
ACETYLCHOLINE REC BLOCKING AB,17605558,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,23,139.4,
RICKETTSIA DIEASE PANEL (FACTOR VIII-VW),17605559,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
SWINE (H1N1) FLU,17605566,CDM,306,RC,87502,HCPCS,OUTPATIENT,,,463.00,185.20,,,,,,other ,not seperately reimbursable,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.8,60,,222.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,393.55,85,,314.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,324.1,70,,259.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,148.16,32,,118.53,percent of total billed charges,32% of total billed charges,119.75,393.55,
BORDETELLA PERTUSSIS DNA QUAL REAL TIME,17605567,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,43.86,157.25,
VITAMIN D-25 HYDROXY (CALCIFERD),17605569,CDM,301,RC,82306,HCPCS,OUTPATIENT,,,157.00,62.80,,27.41,100,,,fee schedule,100% of Aetna fee schedule,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,114.27,272,,,fee schedule,272% of BCBS fee schedule,114.27,272,,,fee schedule,272% of BCBS fee schedule,114.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,27.41,133.45,
ACYLCARNITINES,17605579,CDM,301,RC,82017,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,18.9,272,,,fee schedule,272% of BCBS fee schedule,18.9,272,,,fee schedule,272% of BCBS fee schedule,18.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,18.9,64.6,
...LAMICTAL,17605589,CDM,301,RC,80175,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,16.56,53.55,
CMP W/GFR,17605590,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,120.00,48.00,,9.78,100,,,fee schedule,100% of Aetna fee schedule,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,39.74,272,,,fee schedule,272% of BCBS fee schedule,39.74,272,,,fee schedule,272% of BCBS fee schedule,39.74,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,9.78,102,
T3 UPTAKE,17605594,CDM,301,RC,84479,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,8.08,53.55,
.CLINITEST (REDUCING SUBSTANCES),17605595,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,4.35,45.9,
CLINITEST (REDUCING SUBSTANCES),17605596,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
"FACTOR II, ACTIVITY, CLOTTING",17605597,CDM,305,RC,85210,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
PURKIN je CELL CYTOPLAS Ab,17605598,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,15.06,46.54,
PLAVIX (R) P450 2C19 GENOTYPE,17605599,CDM,310,RC,81226,HCPCS,OUTPATIENT,,,2160.00,864.00,,,,,,other ,not seperately reimbursable,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1296,60,,1036.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,563.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,1836,85,,1468.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,1512,70,,1209.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,691.2,32,,552.96,percent of total billed charges,32% of total billed charges,563.63,1836,
ZO NOT USE 072402,17605657,CDM,302,RC,86706,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,13.42,45.9,
SEMEN ANALYSIS (POST-VAS),17605658,CDM,309,RC,89310,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,33.21,272,,,fee schedule,272% of BCBS fee schedule,33.21,272,,,fee schedule,272% of BCBS fee schedule,33.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,10.76,51,
SEMEN ANALYSIS (COMPLETE),17605659,CDM,309,RC,89320,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.38,46.75,
M CKMB,17605660,CDM,301,RC,82553,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,34.98,272,,,fee schedule,272% of BCBS fee schedule,34.98,272,,,fee schedule,272% of BCBS fee schedule,34.98,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,14.43,68.85,
.M CKMB,17605661,CDM,301,RC,82553,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,34.98,272,,,fee schedule,272% of BCBS fee schedule,34.98,272,,,fee schedule,272% of BCBS fee schedule,34.98,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,14.43,68.85,
RUBELLA IgM ANTIBODY,17605663,CDM,302,RC,86762,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,17.98,56.1,
RUBELLA IgG AB,17605664,CDM,302,RC,86762,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,17.98,56.1,
CULTURE VIRAL,17605665,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.64,272,,,fee schedule,272% of BCBS fee schedule,100.64,272,,,fee schedule,272% of BCBS fee schedule,100.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,32.58,100.64,
GLUCOSE TT(PP2HR),17605667,CDM,301,RC,82951,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,16.08,64.6,
MYCOPLASMA IGM,17605668,CDM,302,RC,86738,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51.14,272,,,fee schedule,272% of BCBS fee schedule,51.14,272,,,fee schedule,272% of BCBS fee schedule,51.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.55,51.14,
MYCOPLASMA AB(IGG/IGM),17605669,CDM,302,RC,86738,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51.14,272,,,fee schedule,272% of BCBS fee schedule,51.14,272,,,fee schedule,272% of BCBS fee schedule,51.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.55,51.14,
HIV RNA (PEDIATRIC),17605670,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
HIV RNA (ADULT),17605671,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
ZO NOT USE,17605672,CDM,302,RC,80074,HCPCS,OUTPATIENT,,,223.00,89.20,,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,133.8,60,,107.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,59.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,156.1,70,,124.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,59.53,189.55,
DRUG SCREEN-COMA/OD (URINE & BLOOD),17605673,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DRUG SCREEN (COLLECTION ONLY),17605674,CDM,301,RC,99000,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
*****EPSTEIN BARR-AB (IGG/IGM),17605675,CDM,302,RC,86664,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,19.11,76.5,
DRUG SCREEN-CHAIN OF CUSTODY (URINE),17605676,CDM,301,RC,99000,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
BB TYPE AND SCREEN  (REFERENCE),17605677,CDM,300,RC,86850,HCPCS,OUTPATIENT,,,140.00,56.00,,9.77,100,,,fee schedule,100% of Aetna fee schedule,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,9.77,119,
GLUCOSE (FASTING),17605678,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,15.15,272,,,fee schedule,272% of BCBS fee schedule,15.15,272,,,fee schedule,272% of BCBS fee schedule,15.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,4.91,25.5,
DRUG CONFIRMATION (GC/MS),17605680,CDM,301,RC,80375,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,62.91,272,,,fee schedule,272% of BCBS fee schedule,62.91,272,,,fee schedule,272% of BCBS fee schedule,62.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
GENTAMICIN (PEAK),17605681,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,63.27,272,,,fee schedule,272% of BCBS fee schedule,63.27,272,,,fee schedule,272% of BCBS fee schedule,63.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,20.47,68.85,
GENTAMICIN (TROUGH),17605682,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,63.27,272,,,fee schedule,272% of BCBS fee schedule,63.27,272,,,fee schedule,272% of BCBS fee schedule,63.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,20.47,68.85,
GENTAMICIN (RANDOM),17605683,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,63.27,272,,,fee schedule,272% of BCBS fee schedule,63.27,272,,,fee schedule,272% of BCBS fee schedule,63.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,20.47,68.85,
OBSTETRIC PANEL,17605684,CDM,300,RC,80055,HCPCS,OUTPATIENT,,,152.00,60.80,,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,60,,72.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,59.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,106.4,70,,85.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,129.2,
CULTURE URINE,17605685,CDM,306,RC,87086,HCPCS,OUTPATIENT,,,38.00,15.20,,7.47,100,,,fee schedule,100% of Aetna fee schedule,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,31.17,272,,,fee schedule,272% of BCBS fee schedule,31.17,272,,,fee schedule,272% of BCBS fee schedule,31.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,7.47,32.3,
CULTURE THROAT,17605686,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
CULTURE STOOL,17605687,CDM,306,RC,87045,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.42,272,,,fee schedule,272% of BCBS fee schedule,36.42,272,,,fee schedule,272% of BCBS fee schedule,36.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,11.8,36.55,
CULTURE NOSE,17605688,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
FUNGUS STAIN,17605689,CDM,306,RC,87206,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,20.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,6.73,21.25,
GONORRHEA (APTIMA-UNISEX),17605690,CDM,306,RC,87590,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
CHLAMYDIA (APTIMA-UNISEX),17605691,CDM,306,RC,87490,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
CULTURE CMV-CSF-PCR,17605692,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.64,272,,,fee schedule,272% of BCBS fee schedule,100.64,272,,,fee schedule,272% of BCBS fee schedule,100.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,32.58,100.64,
UA MICROSCOPIC ONLY,17605693,CDM,307,RC,81015,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,10.83,272,,,fee schedule,272% of BCBS fee schedule,10.83,272,,,fee schedule,272% of BCBS fee schedule,10.83,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,3.81,22.95,
URINALYSIS W REFLEX CULTURE,17605694,CDM,307,RC,81003,HCPCS,OUTPATIENT,,,25.00,10.00,,2.08,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8.65,272,,,fee schedule,272% of BCBS fee schedule,8.65,272,,,fee schedule,272% of BCBS fee schedule,8.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,2.08,21.25,
WBC REMOVAL SET,17605696,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
****ZZBB ADMINISTRATION FEE,17605697,CDM,390,RC,,,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
BB FILTER(ADMIN),17605698,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
BB DONOR BLOOD BAG,17605699,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
URINALYSIS O/P,17605700,CDM,307,RC,81003,HCPCS,OUTPATIENT,,,25.00,10.00,,2.08,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8.65,272,,,fee schedule,272% of BCBS fee schedule,8.65,272,,,fee schedule,272% of BCBS fee schedule,8.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,2.08,21.25,
"CHLAM-GONORRHEA(URINE,URETHRAL,ENDOCERVI",17605701,CDM,306,RC,87491,HCPCS,OUTPATIENT,,,157.00,62.80,,32.5,100,,,fee schedule,100% of Aetna fee schedule,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,32.5,133.45,
"**CHLAM-GON(URINE,URETHRAL,ENDOCERVICAL)",17605702,CDM,306,RC,87591,HCPCS,OUTPATIENT,,,157.00,62.80,,32.5,100,,,fee schedule,100% of Aetna fee schedule,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,32.5,133.45,
"HEP C RNA QUAL,TMA",17605703,CDM,306,RC,87521,HCPCS,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,43.86,133.45,
***HEP C VIRAL RNA QUAL PER HCV RIBBA W/,17605704,CDM,302,RC,86804,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,58.21,272,,,fee schedule,272% of BCBS fee schedule,58.21,272,,,fee schedule,272% of BCBS fee schedule,58.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.36,59.5,
HEP C ANTIBODY SUPPLEMENT TESTING,17605705,CDM,302,RC,86804,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,58.21,272,,,fee schedule,272% of BCBS fee schedule,58.21,272,,,fee schedule,272% of BCBS fee schedule,58.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.36,59.5,
ESTRADIOL,17605709,CDM,301,RC,82670,HCPCS,OUTPATIENT,,,126.00,50.40,,25.87,100,,,fee schedule,100% of Aetna fee schedule,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.88,272,,,fee schedule,272% of BCBS fee schedule,107.88,272,,,fee schedule,272% of BCBS fee schedule,107.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,25.87,107.88,
PROGESTERONE,17605741,CDM,301,RC,84144,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.54,272,,,fee schedule,272% of BCBS fee schedule,80.54,272,,,fee schedule,272% of BCBS fee schedule,80.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,26.07,80.75,
PROGESTERONE FREE,17605742,CDM,301,RC,84144,HCPCS,OUTPATIENT,,,230.00,92.00,,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,80.54,272,,,fee schedule,272% of BCBS fee schedule,80.54,272,,,fee schedule,272% of BCBS fee schedule,80.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,138,60,,110.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,161,70,,128.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,26.07,195.5,
AMIODARONE,17605744,CDM,301,RC,80151,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
MSH6 MUTATION HNPCC,17605745,CDM,310,RC,81298,HCPCS,OUTPATIENT,,,5400.00,2160.00,,,,,,other ,not seperately reimbursable,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3240,60,,2592,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,802.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,4590,85,,3672,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,3780,70,,3024,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,1728,32,,1382.4,percent of total billed charges,32% of total billed charges,802.31,4590,
METANEPHRINES(24HR URINE),17605766,CDM,301,RC,83835,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,21.17,68.85,
LYME ANTIBODY SCREEN CSF,17605774,CDM,302,RC,86618,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,56.63,272,,,fee schedule,272% of BCBS fee schedule,56.63,272,,,fee schedule,272% of BCBS fee schedule,56.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,21.28,103.7,
PORPHOBILINOGEN (URINE),17605783,CDM,301,RC,84110,HCPCS,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,32.61,272,,,fee schedule,272% of BCBS fee schedule,32.61,272,,,fee schedule,272% of BCBS fee schedule,32.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,10.55,33.15,
LEGIONELLA AB,17605790,CDM,301,RC,86713,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,59.08,272,,,fee schedule,272% of BCBS fee schedule,59.08,272,,,fee schedule,272% of BCBS fee schedule,59.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,19.12,59.08,
"AMINOLEVULINIC ACID, DELTA (24 HR URINE)",17605791,CDM,301,RC,82135,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.54,272,,,fee schedule,272% of BCBS fee schedule,63.54,272,,,fee schedule,272% of BCBS fee schedule,63.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,20.56,63.75,
FACTOR IX,17605792,CDM,305,RC,85250,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.49,272,,,fee schedule,272% of BCBS fee schedule,73.49,272,,,fee schedule,272% of BCBS fee schedule,73.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,23.8,73.49,
5-HIAA(RANDOM),17605799,CDM,301,RC,83497,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.78,272,,,fee schedule,272% of BCBS fee schedule,49.78,272,,,fee schedule,272% of BCBS fee schedule,49.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.12,49.78,
LUTEINIZING HORMONE(LH),17605808,CDM,301,RC,83002,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.51,272,,,fee schedule,272% of BCBS fee schedule,71.51,272,,,fee schedule,272% of BCBS fee schedule,71.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,23.15,71.51,
ESTROGEN,17605816,CDM,301,RC,82671,HCPCS,OUTPATIENT,,,145.00,58.00,,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,124.68,272,,,fee schedule,272% of BCBS fee schedule,124.68,272,,,fee schedule,272% of BCBS fee schedule,124.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,87,60,,69.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,40.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,101.5,70,,81.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,40.37,124.68,
HGB A1C,17605832,CDM,301,RC,83036,HCPCS,OUTPATIENT,,,66.00,26.40,,8.99,100,,,fee schedule,100% of Aetna fee schedule,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,37.48,272,,,fee schedule,272% of BCBS fee schedule,37.48,272,,,fee schedule,272% of BCBS fee schedule,37.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,8.99,56.1,
PROTEIN(24HR URINE) REFERENCE,17605840,CDM,301,RC,84156,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,4.58,16.15,
PROTOPORPHYRIN-FREE ERYTHROSCYTE,17605842,CDM,301,RC,84202,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,28.7,272,,,fee schedule,272% of BCBS fee schedule,28.7,272,,,fee schedule,272% of BCBS fee schedule,28.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
CRYPTOCOCCAL AG TITER,17605843,CDM,302,RC,86403,HCPCS,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,14.42,41.65,
OJ AUTOANTIBODIES,17605861,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,22.41,73.1,
WBC (STOOL),17605873,CDM,306,RC,89055,HCPCS,OUTPATIENT,,,30.10,12.04,,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18.06,60,,14.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,25.59,85,,20.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,21.07,70,,16.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,5.33,25.59,
DESIPRAMINE/NORPRAMINE,17605881,CDM,301,RC,80160,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
IMIPRAMINE (TOFRANIL),17605893,CDM,302,RC,80174,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
*****DAU-8 (RAPID DRUG TEST),17605896,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
FRUCTOSAMINE,17605897,CDM,301,RC,82985,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,58.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,20.95,58.18,
TELOPEPTIDE (URINE),17605899,CDM,301,RC,82523,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,23.35,71.4,
CA-125 CANCER ANTIGEN,17605915,CDM,302,RC,86304,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,26.01,79.05,
DHEA (DEHYDRIEOIANDROESTERONE),17605923,CDM,301,RC,82626,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,97.57,272,,,fee schedule,272% of BCBS fee schedule,97.57,272,,,fee schedule,272% of BCBS fee schedule,97.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,31.58,97.57,
OSMOLALITY  24HR URINE,17605925,CDM,301,RC,83935,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,26.3,272,,,fee schedule,272% of BCBS fee schedule,26.3,272,,,fee schedule,272% of BCBS fee schedule,26.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,8.52,28.05,
CYSTINE (URINE),17605931,CDM,301,RC,82615,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,31.52,272,,,fee schedule,272% of BCBS fee schedule,31.52,272,,,fee schedule,272% of BCBS fee schedule,31.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,11.93,32.3,
CELL COUNT (CSF) RBC/WBC,17605949,CDM,300,RC,89050,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,5.9,19.55,
CSF (CELL COUNT),17605950,CDM,300,RC,89050,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,5.9,19.55,
CRYSTALS (BODY FLUIDS),17605956,CDM,301,RC,89060,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,27.61,272,,,fee schedule,272% of BCBS fee schedule,27.61,272,,,fee schedule,272% of BCBS fee schedule,27.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,9.16,28.9,
ALPHA-1-ANTITRYPSIN QUANT,17605964,CDM,301,RC,82103,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,51.84,272,,,fee schedule,272% of BCBS fee schedule,51.84,272,,,fee schedule,272% of BCBS fee schedule,51.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,16.8,51.84,
ALPHA-1-ANTITRYPSIN PHENOTYPE,17605972,CDM,301,RC,82104,HCPCS,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,55.81,272,,,fee schedule,272% of BCBS fee schedule,55.81,272,,,fee schedule,272% of BCBS fee schedule,55.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,18.07,150.45,
ESTRIOL,17605973,CDM,301,RC,82677,HCPCS,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,93.38,272,,,fee schedule,272% of BCBS fee schedule,93.38,272,,,fee schedule,272% of BCBS fee schedule,93.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,30.22,93.38,
FACTOR V,17605975,CDM,305,RC,85220,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68.14,272,,,fee schedule,272% of BCBS fee schedule,68.14,272,,,fee schedule,272% of BCBS fee schedule,68.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,22.06,68.14,
CALCIUM (IONIZED),17605980,CDM,301,RC,82330,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.77,272,,,fee schedule,272% of BCBS fee schedule,52.77,272,,,fee schedule,272% of BCBS fee schedule,52.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17.1,53.55,
EHRLICHIA CHAFFEENSIS DNA Real-Time PCR,17605981,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,112.06,
CA 15-3,17605983,CDM,302,RC,86300,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,26.01,79.05,
ALPRAZOLAM URINE,17605984,CDM,301,RC,80306,HCPCS,OUTPATIENT,,,80.00,32.00,,13.47,100,,,fee schedule,100% of Aetna fee schedule,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,13.47,68,
OSTEOMARK,17605987,CDM,301,RC,82523,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,23.35,71.4,
NMP 22 (NUCLEAR MATRIX PROTIENS),17605988,CDM,302,RC,86316,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,26.01,79.05,
CERULOPLASMIN,17605998,CDM,301,RC,82390,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.42,42.5,
PYRETHRUM,17606003,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,33.00,13.20,,4.83,100,,,fee schedule,100% of Aetna fee schedule,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,4.83,28.05,
CLOSTRIDIUM DIFF-TOXIN,17606017,CDM,302,RC,86403,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,14.42,40.8,
CMV AB IGM ( CYTOMEGALOVIRUS),17606020,CDM,302,RC,86645,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,65.04,272,,,fee schedule,272% of BCBS fee schedule,65.04,272,,,fee schedule,272% of BCBS fee schedule,65.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,21.06,65.04,
MYELOPEROXIDASE  ANTIBODY,17606025,CDM,302,RC,86021,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,57.64,
DHEA SULFATE,17606038,CDM,301,RC,82627,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,85.84,272,,,fee schedule,272% of BCBS fee schedule,85.84,272,,,fee schedule,272% of BCBS fee schedule,85.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,27.78,96.9,
EOSINOPHIL CT/NASAL,17606046,CDM,305,RC,89190,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.23,19.55,
PARASITE ID(MACRO PARASITE),17606049,CDM,306,RC,87169,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.38,17.85,
GLUCOSE TT(5HR),17606053,CDM,301,RC,82951,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,43.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,16.08,64.6,
HBSAB (HEP B SURF AB),17606061,CDM,302,RC,86706,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.42,42.5,
CULTURE HERPES SIMPLEX,17606087,CDM,306,RC,87255,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
IGA-IMMUNOGLOBLULIN A,17606095,CDM,301,RC,82787,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,46.84,
IGD-IMMUNOGLOGLULIN D,17606103,CDM,301,RC,82787,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,46.84,
IGG-IMMUNOGLOBULIN G,17606111,CDM,301,RC,82787,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,46.84,
17-HYDROXYPREGNENOLONE,17606113,CDM,301,RC,84143,HCPCS,OUTPATIENT,,,103.00,41.20,,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,88.1,272,,,fee schedule,272% of BCBS fee schedule,88.1,272,,,fee schedule,272% of BCBS fee schedule,88.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,61.8,60,,49.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,72.1,70,,57.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,28.51,88.1,
IGM-IMMUNOGLOBULIN M,17606129,CDM,301,RC,82787,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,46.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,46.84,
NATURAL KILLER CELLS,17606130,CDM,302,RC,86357,HCPCS,OUTPATIENT,,,77.00,30.80,,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.2,60,,36.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,53.9,70,,43.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,32,,19.71,percent of total billed charges,32% of total billed charges,24.64,65.45,
Mi-2 AUTOANTIBODIES,17606153,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,22.41,96.05,
STOOL PH,17606178,CDM,301,RC,83986,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.82,272,,,fee schedule,272% of BCBS fee schedule,13.82,272,,,fee schedule,272% of BCBS fee schedule,13.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,4.47,36.55,
REDUCING SUBSTANCES (URINE),17606186,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.35,11.9,
TOBRAMYCIN (PEAK),17606202,CDM,301,RC,80200,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,62.23,272,,,fee schedule,272% of BCBS fee schedule,62.23,272,,,fee schedule,272% of BCBS fee schedule,62.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,20.16,62.23,
TOBRAMYCIN (RANDOM),17606203,CDM,301,RC,80200,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,62.23,272,,,fee schedule,272% of BCBS fee schedule,62.23,272,,,fee schedule,272% of BCBS fee schedule,62.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,20.16,62.23,
TOBRAMYCIN (TROUGH),17606204,CDM,301,RC,80200,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,62.23,272,,,fee schedule,272% of BCBS fee schedule,62.23,272,,,fee schedule,272% of BCBS fee schedule,62.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,20.16,62.23,
PLATELET COUNT,17606252,CDM,305,RC,85049,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,5.6,24.65,
LYMPHOCYTE SUBSET PANEL 4,17606255,CDM,302,RC,86360,HCPCS,OUTPATIENT,,,223.00,89.20,,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,133.8,60,,107.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,156.1,70,,124.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,26.28,189.55,
5-HIAA(24HR URINE),17606277,CDM,301,RC,83497,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.78,272,,,fee schedule,272% of BCBS fee schedule,49.78,272,,,fee schedule,272% of BCBS fee schedule,49.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.12,49.78,
CARBON MONOXIDE (CARBOXYHEMOGLOBIN),17606301,CDM,301,RC,82375,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,272,,,fee schedule,272% of BCBS fee schedule,47.6,272,,,fee schedule,272% of BCBS fee schedule,47.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.4,47.6,
NAPROXEN,17606319,CDM,301,RC,80329,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,107.6,272,,,fee schedule,272% of BCBS fee schedule,107.6,272,,,fee schedule,272% of BCBS fee schedule,107.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,107.6,
TISSUE GROSS ONLY,17606335,CDM,310,RC,88300,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,27.2,272,,,fee schedule,272% of BCBS fee schedule,27.2,272,,,fee schedule,272% of BCBS fee schedule,27.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.21,42.5,
CYTO SMEAR F/W/B CONCENTRATION,17606336,CDM,310,RC,88108,HCPCS,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,50.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,50.58,141.95,
CYTO SMEAR F/W/B THIN PREP,17606337,CDM,310,RC,88112,HCPCS,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,46.93,141.95,
17 HYDROXYPROGESTERONE,17606599,CDM,301,RC,83498,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,104.86,272,,,fee schedule,272% of BCBS fee schedule,104.86,272,,,fee schedule,272% of BCBS fee schedule,104.86,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,33.96,104.86,
AST (SGOT)  GENERIC,17606604,CDM,300,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
ALT(SGPT)  GENERIC,17606605,CDM,300,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
CREATINE KINASE(CK) ISOENZYMES,17606608,CDM,301,RC,82552,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,51.71,272,,,fee schedule,272% of BCBS fee schedule,51.71,272,,,fee schedule,272% of BCBS fee schedule,51.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,51.71,
TSH,17606609,CDM,301,RC,84443,HCPCS,OUTPATIENT,,,101.00,40.40,,15.56,100,,,fee schedule,100% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,64.84,272,,,fee schedule,272% of BCBS fee schedule,64.84,272,,,fee schedule,272% of BCBS fee schedule,64.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,15.56,85.85,
FE (IRON)  GENERIC,17606616,CDM,301,RC,83540,HCPCS,OUTPATIENT,,,18.00,7.20,,5.99,100,,,fee schedule,100% of Aetna fee schedule,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,25.02,
HEP C HEPTIMAX RNA QUANT,17606619,CDM,306,RC,87522,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,53.55,163.2,
H&H PANEL,17606633,CDM,300,RC,85018,HCPCS,OUTPATIENT,,,29.30,11.72,,,,,,other ,not seperately reimbursable,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,9.11,272,,,fee schedule,272% of BCBS fee schedule,9.11,272,,,fee schedule,272% of BCBS fee schedule,9.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.58,60,,14.06,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,24.91,85,,19.93,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,20.51,70,,16.41,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,9.38,32,,7.5,percent of total billed charges,32% of total billed charges,2.96,24.91,
CANDIDA ANTIGEN DETECTOR,17606634,CDM,302,RC,86403,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,39.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,14.42,40.8,
.ALPHA-FETO PROTEIN (TUMOR MARKER),17606635,CDM,301,RC,82105,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.76,272,,,fee schedule,272% of BCBS fee schedule,64.76,272,,,fee schedule,272% of BCBS fee schedule,64.76,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,20.96,64.76,
.ORGANIC ACID QUANT (URINE),17606636,CDM,301,RC,83918,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,57.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
HEP B CORE ANTIBODY IGM IGG,17606637,CDM,302,RC,86704,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,45.32,272,,,fee schedule,272% of BCBS fee schedule,45.32,272,,,fee schedule,272% of BCBS fee schedule,45.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
PLASMA HEMOGLOBIN,17606638,CDM,301,RC,83051,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,28.21,272,,,fee schedule,272% of BCBS fee schedule,28.21,272,,,fee schedule,272% of BCBS fee schedule,28.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,9.13,29.75,
.PATHOLOGIST BLOOD SLIDE REVIEW,17606639,CDM,310,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
SPECIAL TYPING PER ANTIGEN,17606640,CDM,390,RC,86905,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,14.77,272,,,fee schedule,272% of BCBS fee schedule,14.77,272,,,fee schedule,272% of BCBS fee schedule,14.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
BB APHERESIS PLATELETS HLA MATCHED,17606642,CDM,384,RC,36430,HCPCS,OUTPATIENT,,,739.00,295.60,,,,,,other ,not seperately reimbursable,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.4,60,,354.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,628.15,85,,502.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,517.3,70,,413.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,236.48,32,,189.18,percent of total billed charges,32% of total billed charges,46.33,628.15,
AMINO ACID SCREEN QUAL PLASMA,17606643,CDM,301,RC,82128,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,17.33,54.4,
AMINO ACID SCREEN QUAL URINE,17606644,CDM,301,RC,82128,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,53.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,17.33,54.4,
CULTURE FUNGUS (BLOOD),17606645,CDM,306,RC,87103,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.57,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
VDRL (SERUM),17606646,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
CSF VDRL(C360),17606647,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
ARGININE VASOPRESSIN (URINE),17606648,CDM,301,RC,,,OUTPATIENT,,,152.00,60.80,,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,60,,72.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,106.4,70,,85.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,129.2,
ARGININE VASOPRESSIN (BLD)FROZEN**,17606649,CDM,301,RC,84588,HCPCS,OUTPATIENT,,,152.00,60.80,,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,131.05,272,,,fee schedule,272% of BCBS fee schedule,131.05,272,,,fee schedule,272% of BCBS fee schedule,131.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,91.2,60,,72.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,106.4,70,,85.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,48.64,32,,38.91,percent of total billed charges,32% of total billed charges,42.42,131.05,
.FECAL FAT QUANTITATIVE,17606650,CDM,301,RC,82710,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,59.51,272,,,fee schedule,272% of BCBS fee schedule,59.51,272,,,fee schedule,272% of BCBS fee schedule,59.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,21,60.35,
HIV-I/II Ab W/REFLEX TO WESTERN BLOT,17606651,CDM,302,RC,86703,HCPCS,OUTPATIENT,,,58.00,23.20,,12.69,100,,,fee schedule,100% of Aetna fee schedule,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,51.73,272,,,fee schedule,272% of BCBS fee schedule,51.73,272,,,fee schedule,272% of BCBS fee schedule,51.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,12.69,51.73,
SHIGA TOXINS E.COLI,17606652,CDM,306,RC,87427,HCPCS,OUTPATIENT,,,44.29,17.72,,,,,,other ,not seperately reimbursable,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.57,60,,21.26,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,37.65,85,,30.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,31,70,,24.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,14.17,32,,11.34,percent of total billed charges,32% of total billed charges,14.17,37.65,
ACETYLCHOLINE REC BINDING AB,17607001,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,23,139.4,
"ACTH, PLASMA",17607002,CDM,301,RC,82024,HCPCS,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,149.14,272,,,fee schedule,272% of BCBS fee schedule,149.14,272,,,fee schedule,272% of BCBS fee schedule,149.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,48.27,149.14,
ALK PHOS ISOENZYMES,17607003,CDM,301,RC,84080,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,57.09,272,,,fee schedule,272% of BCBS fee schedule,57.09,272,,,fee schedule,272% of BCBS fee schedule,57.09,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,18.47,61.2,
AMITRIPTYLINE (ELAVIL),17607006,CDM,301,RC,80152,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
.ANTI THYROID MICROSOMAL ANTIBODY,17607007,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,18.18,56.17,
ANTI-STREPTOLYSIN (ASO),17607008,CDM,302,RC,86060,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,28.18,272,,,fee schedule,272% of BCBS fee schedule,28.18,272,,,fee schedule,272% of BCBS fee schedule,28.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,9.12,29.75,
****DNA (DEOXYRIBONUCLEIC ACID AB),17607009,CDM,302,RC,86225,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.04,272,,,fee schedule,272% of BCBS fee schedule,53.04,272,,,fee schedule,272% of BCBS fee schedule,53.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17.17,53.55,
BENCE JONES PROTEIN,17607012,CDM,301,RC,84165,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,41.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.42,42.5,
****CHLAMYDIA GRP AB BLOOD,17607013,CDM,302,RC,86631,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.77,45.9,
CHOLINESTERASE RBC,17607014,CDM,301,RC,82482,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.36,272,,,fee schedule,272% of BCBS fee schedule,22.36,272,,,fee schedule,272% of BCBS fee schedule,22.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,12.26,58.65,
CULTURE ANAEROBIC,17607015,CDM,306,RC,87075,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.53,272,,,fee schedule,272% of BCBS fee schedule,36.53,272,,,fee schedule,272% of BCBS fee schedule,36.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,11.83,36.55,
H-PYLORI IgG AB (REFERENCE),17607016,CDM,302,RC,86677,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.06,56.1,
C 5 COMPLEMENT,17607017,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15,46.75,
TOTAL SPEC SALIVARY IgA ANTIBODY,17607018,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,42.00,16.80,,8.61,100,,,fee schedule,100% of Aetna fee schedule,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,8.61,35.9,
ENTEROVIRUS CULTURE,17607019,CDM,306,RC,87254,HCPCS,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,24.45,75.65,
HETEROPHILE ANTIBODIES,17607020,CDM,302,RC,86308,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,6.47,20.4,
PROTEIN ELECT (24HR URINE),17607021,CDM,301,RC,84166,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,22.28,68.85,
FECAL FATS & FIBER,17607022,CDM,306,RC,89125,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.67,272,,,fee schedule,272% of BCBS fee schedule,16.67,272,,,fee schedule,272% of BCBS fee schedule,16.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
FECAL FAT(72 HR)QUANTITATIVE,17607023,CDM,301,RC,82710,HCPCS,OUTPATIENT,,,166.00,66.40,,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,59.51,272,,,fee schedule,272% of BCBS fee schedule,59.51,272,,,fee schedule,272% of BCBS fee schedule,59.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,21,141.1,
H-PYLORI STOOL AG,17607024,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,8.28,27.2,
PROTEIN TOTAL(URINE) REFERENCE,17607025,CDM,301,RC,84156,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,4.58,16.15,
HYDROXYPROLINE TOTAL(24HR URINE),17607026,CDM,301,RC,83505,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.84,272,,,fee schedule,272% of BCBS fee schedule,93.84,272,,,fee schedule,272% of BCBS fee schedule,93.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,30.37,93.84,
LYME TITER,17607027,CDM,302,RC,86617,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,59.79,272,,,fee schedule,272% of BCBS fee schedule,59.79,272,,,fee schedule,272% of BCBS fee schedule,59.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,19.36,103.7,
MHA-TP,17607029,CDM,302,RC,86780,HCPCS,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,51.11,272,,,fee schedule,272% of BCBS fee schedule,51.11,272,,,fee schedule,272% of BCBS fee schedule,51.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,51.11,
MYCOPLASMA TITER,17607030,CDM,302,RC,86738,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51.14,272,,,fee schedule,272% of BCBS fee schedule,51.14,272,,,fee schedule,272% of BCBS fee schedule,51.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.55,51.14,
NORPRAMIN (DESIPRAMINE),17607031,CDM,301,RC,80160,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
NORTRIPTYLINE (AVENTYL),17607032,CDM,301,RC,80182,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
PROTEIN ELECT(URINE) RANDOM,17607034,CDM,301,RC,84166,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,22.28,61.2,
QUINIDINE,17607036,CDM,301,RC,80194,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.36,272,,,fee schedule,272% of BCBS fee schedule,56.36,272,,,fee schedule,272% of BCBS fee schedule,56.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,18.25,56.95,
CYSTINE (24HR URINE),17607037,CDM,301,RC,82615,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,31.52,272,,,fee schedule,272% of BCBS fee schedule,31.52,272,,,fee schedule,272% of BCBS fee schedule,31.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,11.93,32.3,
"ACID PHOS,TARTRATE RESISTANT",17607038,CDM,301,RC,84311,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,10.12,35.7,
CLOTTING TIME (THROMBIN),17607039,CDM,305,RC,85670,HCPCS,OUTPATIENT,,,49.71,19.88,,,,,,other ,not seperately reimbursable,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,29.83,60,,23.86,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,42.25,85,,33.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,34.8,70,,27.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,15.91,32,,12.73,percent of total billed charges,32% of total billed charges,7.21,42.25,
ROTAVIRUS ABS,17607040,CDM,302,RC,87425,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,14.97,51,
TWAR,17607041,CDM,302,RC,86631,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.77,45.9,
TRANSFERRIN,17607042,CDM,301,RC,84466,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.31,272,,,fee schedule,272% of BCBS fee schedule,49.31,272,,,fee schedule,272% of BCBS fee schedule,49.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,15.95,49.31,
TORCH PROFILE,17607043,CDM,302,RC,,,OUTPATIENT,,,261.00,104.40,,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.6,60,,125.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,182.7,70,,146.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,221.85,
TAY SACHS SCREENING,17607044,CDM,301,RC,81255,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,64.31,
TOXOPLASMA(IGG/IGM)ANTIBODIES,17607045,CDM,302,RC,86777,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,17.98,56.1,
.THYROID MICROSOMAL ANTIBODY,17607046,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,18.18,56.17,
LIVER KIDNEY MICROSOMAL ANTIBODY,17607047,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,18.18,56.17,
VANCOMYCIN (PEAK),17607048,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,16.92,94.35,
VANCOMYCIN (RANDOM),17607049,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,16.92,94.35,
VANCOMYCIN (TROUGH),17607050,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,16.92,74.8,
MOLECULE DIAGNOSTIC,17607052,CDM,301,RC,83892,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
"MOLECULE NUCLEIC AMPLI, EACH",17607053,CDM,301,RC,83898,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
PREPPF ARRAY-BASED EVALUATION,17607054,CDM,302,RC,88386,HCPCS,OUTPATIENT,,,847.00,338.80,,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,508.2,60,,406.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,719.95,85,,575.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,592.9,70,,474.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,32,,216.83,percent of total billed charges,32% of total billed charges,271.04,719.95,
SULFATE 24HR URINE,17607055,CDM,301,RC,84392,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.86,19.55,
FELBAMATE (FELBATOL),17607061,CDM,301,RC,80167,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
GLUCOSE (1HR) GESTATIONAL,17607064,CDM,301,RC,82950,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.48,272,,,fee schedule,272% of BCBS fee schedule,15.48,272,,,fee schedule,272% of BCBS fee schedule,15.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,5.93,18.7,
GIARDIA ANTIGEN  EIA STOOL,17607065,CDM,306,RC,87328,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.27,46.75,
BB CROSSMATCH (REFERENCE),17607066,CDM,390,RC,86922,HCPCS,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,119,
CAT SCRATCH FEVER(BARTONELLA AB),17607070,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
CH 50,17607071,CDM,302,RC,86162,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,78.42,272,,,fee schedule,272% of BCBS fee schedule,78.42,272,,,fee schedule,272% of BCBS fee schedule,78.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,25.4,79.05,
"ANTI DNA DBL STRANDED (DNA AB, NATIVE)",17607072,CDM,302,RC,86225,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,53.04,272,,,fee schedule,272% of BCBS fee schedule,53.04,272,,,fee schedule,272% of BCBS fee schedule,53.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,17.17,53.04,
ANTI CARDIOLIPIN ANTIBODIES,17607073,CDM,302,RC,86147,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,62.21,272,,,fee schedule,272% of BCBS fee schedule,62.21,272,,,fee schedule,272% of BCBS fee schedule,62.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
ANTI THROMBIN III (CLOTTING INHIBITORS),17607074,CDM,305,RC,85300,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
PROTEIN C - ACTIVITY,17607075,CDM,305,RC,85303,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,53.39,272,,,fee schedule,272% of BCBS fee schedule,53.39,272,,,fee schedule,272% of BCBS fee schedule,53.39,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,17.3,54.4,
LUPUS ANTICOAGULANT PROFILE,17607076,CDM,305,RC,85613,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.94,272,,,fee schedule,272% of BCBS fee schedule,36.94,272,,,fee schedule,272% of BCBS fee schedule,36.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,11.97,36.94,
MOLECULE MUTATION SCAN #1,17607077,CDM,302,RC,83903,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
RASH PROFILE A,17607080,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RASH PROFILE B,17607081,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
HIV 1 ANTIGEN (P24HIV),17607082,CDM,306,RC,87390,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,42,272,,,fee schedule,272% of BCBS fee schedule,42,272,,,fee schedule,272% of BCBS fee schedule,42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
"HIV DNA, QUALITATIVE  PCR",17607083,CDM,306,RC,87535,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
RAST ALLERGEN PROFILE,17607084,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
VARICELLA  ZOSTER AB (IGG),17607085,CDM,302,RC,86787,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
"VARICELLA ZOSTER AB (IgG,IgM)",17607086,CDM,302,RC,86787,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,16.1,55.25,
CA 19 9,17607087,CDM,302,RC,86301,HCPCS,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,26.01,79.05,
.HIV 1/2 AG/AB 4TH GENERTAION,17607093,CDM,306,RC,87389,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,30.1,
.HIV 1 AB,17607094,CDM,302,RC,86701,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,34.3,272,,,fee schedule,272% of BCBS fee schedule,34.3,272,,,fee schedule,272% of BCBS fee schedule,34.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.11,34.3,
.HIV 2 AB,17607095,CDM,302,RC,86702,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,52.2,272,,,fee schedule,272% of BCBS fee schedule,52.2,272,,,fee schedule,272% of BCBS fee schedule,52.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,52.2,
.HIV 1 RNA QUAL TMA,17607096,CDM,306,RC,87535,HCPCS,OUTPATIENT,,,250.00,100.00,,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,43.86,212.5,
CRYPTOSPORIDIUM AG (STOOL),17607111,CDM,306,RC,87328,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.27,46.75,
*T CELL COUNT DO NOT USE 082201,17607113,CDM,302,RC,86359,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,12.02,272,,,fee schedule,272% of BCBS fee schedule,12.02,272,,,fee schedule,272% of BCBS fee schedule,12.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,47.16,
CORTISOL  AM,17607115,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,20.37,62.94,
COCCIDIOIDES ABS,17607220,CDM,302,RC,86635,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,44.28,272,,,fee schedule,272% of BCBS fee schedule,44.28,272,,,fee schedule,272% of BCBS fee schedule,44.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,14.33,45.05,
HISTOPLAMOSIS ANTIBODIES,17607230,CDM,302,RC,86510,HCPCS,OUTPATIENT,,,170.00,68.00,,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102,60,,81.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,119,70,,95.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,9.15,144.5,
KAPPA LIGHT CHAINS URINE 24HR,17607233,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17,53.55,
.KAPPA LIGHT CHAINS URINE 24HR #2,17607234,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,63.00,25.20,59,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17,53.55,
VARICELLA IMMUNITY SCREEN,17607240,CDM,302,RC,86787,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
CAROTENE BETA,17607250,CDM,301,RC,82380,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.6,272,,,fee schedule,272% of BCBS fee schedule,35.6,272,,,fee schedule,272% of BCBS fee schedule,35.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,11.52,35.7,
PTH RELATED PROTIEN PTH-rp,17607251,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,175.00,70.00,,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,23,148.75,
NEURONTIN (GABAPENTIN),17607260,CDM,301,RC,80171,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
"NEUTROPHIL FUNCTION, OXIDATIVE BURST",17607261,CDM,302,RC,88184,HCPCS,OUTPATIENT,,,484.00,193.60,,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,81.66,411.4,
COXSACKIE B PANEL Q#7656X,17607262,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE B PANEL #2,17607263,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE B PANEL #3,17607264,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
CHLAMYDIA IgG AB BLOOD TITER,17607265,CDM,302,RC,86631,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.77,45.9,
COXSACKIE B PANEL #4,17607266,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE B PANEL #5,17607267,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE B PANEL #6,17607268,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
BENZODIAZEPINES(SERUM)-PANEL 10-ABUSE,17607269,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
CHLAMYDIA PSITTACI,17607270,CDM,302,RC,86631,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,45.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.77,45.9,
"CHROMIUM, BLOOD",17607275,CDM,301,RC,82495,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,78.31,272,,,fee schedule,272% of BCBS fee schedule,78.31,272,,,fee schedule,272% of BCBS fee schedule,78.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,25.35,78.31,
MESANTOIN (MEPHENYTOIN),17607280,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,63.00,25.20,,17.37,100,,,fee schedule,100% of Aetna fee schedule,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17.37,65.52,
SM & SM/RNP ANTIOBODIES(ENA),17607285,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
"T4 FREE,DIRECT DIALYISIS",17607288,CDM,301,RC,84439,HCPCS,OUTPATIENT,,,68.00,27.20,,8.35,100,,,fee schedule,100% of Aetna fee schedule,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,34.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,8.35,57.8,
OSMOLALITY (URINE),17607300,CDM,301,RC,83935,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,26.3,272,,,fee schedule,272% of BCBS fee schedule,26.3,272,,,fee schedule,272% of BCBS fee schedule,26.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,8.52,28.05,
ACETONE(URINE),17607301,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.35,18.7,
RAPAMUNE (SIROLIMUS),17607302,CDM,301,RC,80195,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17.16,53.55,
CALCITONIN,17607303,CDM,301,RC,82308,HCPCS,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,103.39,272,,,fee schedule,272% of BCBS fee schedule,103.39,272,,,fee schedule,272% of BCBS fee schedule,103.39,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,33.48,103.39,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #13,17607304,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
PNEUNO AB IGG 12SEROTYPE PANEL EIA #14,17607305,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.1,49.75,
... RAPAMUNE (SIROLIMUS),17607306,CDM,301,RC,80195,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17.16,53.55,
EPSTEIN BARR DNA QUANT PCR,17607310,CDM,306,RC,87799,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,53.55,163.2,
OSMOLALITY (SERUM),17607320,CDM,301,RC,83930,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,25.51,272,,,fee schedule,272% of BCBS fee schedule,25.51,272,,,fee schedule,272% of BCBS fee schedule,25.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,8.26,27.2,
H-PYLORI IgM AB,17607321,CDM,302,RC,86677,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.06,56.1,
"FISH,UROVYSION (R) BLADDER",17607323,CDM,302,RC,88120,HCPCS,OUTPATIENT,,,402.00,160.80,,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241.2,60,,192.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,502.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,281.4,70,,225.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,32,,102.91,percent of total billed charges,32% of total billed charges,128.64,502.5,
THROMBIN CLOTTING TIME,17607325,CDM,305,RC,85670,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,21.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,7.21,22.95,
CULTURE WOUND,17607326,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
PRESUMPTIVE ID URINE CULTURE,17607327,CDM,306,RC,87077,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,30.36,272,,,fee schedule,272% of BCBS fee schedule,30.36,272,,,fee schedule,272% of BCBS fee schedule,30.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.1,30.36,
CULTURE SPUTUM,17607328,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
CLINDAMYCIN D,17607329,CDM,306,RC,87184,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,26.63,272,,,fee schedule,272% of BCBS fee schedule,26.63,272,,,fee schedule,272% of BCBS fee schedule,26.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,26.63,
BACTERIAL ID,17607330,CDM,306,RC,87184,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,26.63,272,,,fee schedule,272% of BCBS fee schedule,26.63,272,,,fee schedule,272% of BCBS fee schedule,26.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,9.35,28.9,
URINE ID,17607331,CDM,306,RC,87088,HCPCS,OUTPATIENT,,,34.00,13.60,,7.49,100,,,fee schedule,100% of Aetna fee schedule,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,31.23,272,,,fee schedule,272% of BCBS fee schedule,31.23,272,,,fee schedule,272% of BCBS fee schedule,31.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,7.49,31.23,
HALDOL (HALOPERIDOL),17607390,CDM,301,RC,80173,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,19.72,53.55,
COXSACKIE A PANEL,17607391,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE  A PANEL #2,17607392,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE A PANEL #3,17607393,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE A PANEL #4,17607394,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE A PANEL #5,17607395,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
COXSACKIE A PANEL #6,17607396,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,50.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,16.28,50.32,
"EPSTEIN BARR VIRUS,ANTIBODY ANTIGEN D",17607399,CDM,302,RC,86663,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.4,51,
SJOGRENS SYNDROME ABS (SSA SSB),17607500,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
HEP C RNA QUANT DNA,17607522,CDM,302,RC,87522,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,53.55,163.2,
***HEP C VI RNA QUANTITATIVE PCR W/ REFL,17607523,CDM,306,RC,87522,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,53.55,163.2,
***HEP C VI RNA QUALITATIVE PCR,17607524,CDM,302,RC,87521,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,113.9,
RESPIRATORY SYNCYTIAL VIRUS(RSV) CULTURE,17607525,CDM,306,RC,87254,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,24.45,68.85,
FACTOR VII,17607597,CDM,305,RC,85230,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,22.37,69.12,
DEXAMETHASONE SUPPLESSION TEST,17607715,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,20.37,62.94,
"**AMPLIFIED PROBE TECH, EA ORGANISM",17607798,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,112.06,
TRAZODONE (DESYREL),17607896,CDM,301,RC,80338,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
HEAVY METAL (24HR URINE),17608001,CDM,301,RC,83018,HCPCS,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,27.45,84.78,
KLONOPIN (RIVOTRIL/CLONAZEPAM),17608005,CDM,301,RC,80306,HCPCS,OUTPATIENT,,,97.00,38.80,,13.47,100,,,fee schedule,100% of Aetna fee schedule,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,13.47,82.45,
ZINC,17608011,CDM,301,RC,84630,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,43.98,272,,,fee schedule,272% of BCBS fee schedule,43.98,272,,,fee schedule,272% of BCBS fee schedule,43.98,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,14.23,44.2,
RENAL FUNCTION PANEL,17608012,CDM,301,RC,80069,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,10.85,59.5,
GENERAL HEALTH PANEL,17608015,CDM,301,RC,80050,HCPCS,OUTPATIENT,,,272.00,108.80,,24.68,100,,,fee schedule,100% of Aetna fee schedule,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,136.35,272,,,fee schedule,272% of BCBS fee schedule,136.35,272,,,fee schedule,272% of BCBS fee schedule,136.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,163.2,60,,130.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,190.4,70,,152.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,87.04,32,,69.63,percent of total billed charges,32% of total billed charges,24.68,231.2,
.THIAMINE (VITAMIN B-1),17608020,CDM,301,RC,84425,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,32.88,272,,,fee schedule,272% of BCBS fee schedule,32.88,272,,,fee schedule,272% of BCBS fee schedule,32.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
CORTISOL FREE(C360),17608022,CDM,301,RC,82530,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.52,272,,,fee schedule,272% of BCBS fee schedule,64.52,272,,,fee schedule,272% of BCBS fee schedule,64.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,20.88,64.6,
HIV RNA PCR (VIRAL LOAD)QUANT,17608025,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
CORTISOL BINDING GLOBULIN,17608026,CDM,301,RC,84449,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,56.63,272,,,fee schedule,272% of BCBS fee schedule,56.63,272,,,fee schedule,272% of BCBS fee schedule,56.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
"CLONIDINE, BLOOD",17608029,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
ALDOSTERONE (24 HR URINE),17608030,CDM,301,RC,82088,HCPCS,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,157.32,272,,,fee schedule,272% of BCBS fee schedule,157.32,272,,,fee schedule,272% of BCBS fee schedule,157.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,50.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,50.93,157.32,
MICROALBUMIN (24HR URINE)  (IN-HOUSE),17608035,CDM,301,RC,82043,HCPCS,OUTPATIENT,,,60.17,24.07,,,,,,other ,not seperately reimbursable,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.1,60,,28.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,51.14,85,,40.91,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,42.12,70,,33.7,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,19.25,32,,15.4,percent of total billed charges,32% of total billed charges,6.61,51.14,
KETOGENIC STEROIDS 17,17608040,CDM,301,RC,83582,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,54.73,272,,,fee schedule,272% of BCBS fee schedule,54.73,272,,,fee schedule,272% of BCBS fee schedule,54.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,19.33,55.25,
MITOCHONDRIAL ANTIBODY,17608045,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
HEP C ANTIBODY SCREEN,17608050,CDM,302,RC,86803,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,53.67,272,,,fee schedule,272% of BCBS fee schedule,53.67,272,,,fee schedule,272% of BCBS fee schedule,53.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,17.83,55.25,
BB POOLING PLATELETS,17608115,CDM,390,RC,86965,HCPCS,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
BILE ACID FRACT/TOTAL PREGNANCY,17608117,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,80.00,32.00,,17.37,100,,,fee schedule,100% of Aetna fee schedule,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,17.37,68,
IGG-SUBCLASSES (IMMUNOGLOBLULIN G SUBCLA,17608120,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,14.00,5.60,,8.61,100,,,fee schedule,100% of Aetna fee schedule,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,35.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,35.9,
FLOW CYTOME LEUKEMIA/LYMPHOMA EVALUATION,17608123,CDM,302,RC,,,OUTPATIENT,,,108.00,43.20,,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,60,,51.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,75.6,70,,60.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,91.8,
.ANTIPHOSPHOLIPID ANTIBODIES,17608130,CDM,302,RC,86148,HCPCS,OUTPATIENT,,,103.00,41.20,,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.8,60,,49.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,72.1,70,,57.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,20.08,87.55,
ANTIPHOSPHOLIPID PANEL,17608135,CDM,302,RC,86148,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
MEASLES IGG IMMUNE STATUS,17608140,CDM,302,RC,86765,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.1,49.75,
"COCAINE, SERUM",17608141,CDM,301,RC,82520,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
HERPES 1&2 DNA REAL-TIME PCR,17608155,CDM,306,RC,87529,HCPCS,OUTPATIENT,,,134.00,53.60,,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,113.9,
HAAB (HEP A AB),17608160,CDM,302,RC,86708,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,46.57,272,,,fee schedule,272% of BCBS fee schedule,46.57,272,,,fee schedule,272% of BCBS fee schedule,46.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,15.48,47.6,
FLOW CYTOMETRY,17608180,CDM,305,RC,88184,HCPCS,OUTPATIENT,,,484.00,193.60,,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,81.66,411.4,
AMPHETAMINES SERUM,17608214,CDM,301,RC,82145,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
METHAMPHETAMINES SERUM,17608215,CDM,301,RC,82145,HCPCS,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,141.95,
DEXAMETHASONE SUPPRESSION TEST,17608253,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,20.37,62.94,
"DENGUE FEVER Igg, Igm",17608296,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,16.1,60.35,
PL-12 AUTOANTIBODIES,17608316,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,22.41,73.1,
ACETYLCH RECEPTOR BINDING ANTIBODY,17608351,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
IMMUNOASSAY QUANT NOS NONAB,17608352,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,49.99,
GANGLIOSIDE ASIALO-GM1 ANTIBODY,17608355,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,21.58,77.35,
LACTOFERRIN STOOL QUALITATIVE,17608363,CDM,301,RC,83630,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.62,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,24.62,68.85,
"AMP, SIGNAL, EA NUC ACID SEQUENCE",17608390,CDM,301,RC,83908,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
ACETYLCH RECEPTOR BLOCKING ANTIBODY,17608391,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
INTERPRETATION AND REPORT,17608392,CDM,302,RC,83912,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
"ACID PHOSPHATASE, TOTAL",17608406,CDM,301,RC,84066,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,37.29,272,,,fee schedule,272% of BCBS fee schedule,37.29,272,,,fee schedule,272% of BCBS fee schedule,37.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,37.29,
PROTEIN(24HR URINE) IN-HOUSE,17608411,CDM,301,RC,84156,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,4.58,34.85,
MACROPROLACTIN #2,17608416,CDM,301,RC,84146,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,74.8,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,24.22,74.8,
TESTOSTERONE-FREE,17608440,CDM,301,RC,84402,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,31.83,98.3,
EJ AUTOANTIBODIES,17608531,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,14.41,73.1,
LAMB'S QUARTERS(GOOSE FOOT)(W10)IGE,17608600,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
SRP AUTOANTIBODIES,17608623,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,14.41,96.05,
BETA-2-TRANSFERRIN FLUID,17608633,CDM,302,RC,86335,HCPCS,OUTPATIENT,,,230.00,92.00,,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138,60,,110.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,161,70,,128.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,36.68,195.5,
B. HENSELAE IgG TITER,17608661,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
"**HERPES VIRUS 6 AB IgG, IgM #2",17608679,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.1,51,
BB ANTIBODY TITRATION,17608688,CDM,300,RC,86886,HCPCS,OUTPATIENT,,,155.00,62.00,,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,93,60,,74.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,108.5,70,,86.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,6.47,131.75,
CMV AB IGG ELISA CSF,17608690,CDM,302,RC,86644,HCPCS,OUTPATIENT,,,31.25,12.50,,,,,,other ,not seperately reimbursable,10,32,,8,percent of total billed charges,32% of total billed charges,10,32,,8,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18.75,60,,15,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10,32,,8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,32,,8,percent of total billed charges,32% of total billed charges,26.56,85,,21.25,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,32,,8,percent of total billed charges,32% of total billed charges,10,32,,8,percent of total billed charges,32% of total billed charges,21.88,70,,17.5,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10,32,,8,percent of total billed charges,32% of total billed charges,10,32,,8,percent of total billed charges,32% of total billed charges,10,55.57,
CMV AB IGM ELISA CSF,17608691,CDM,302,RC,86645,HCPCS,OUTPATIENT,,,31.00,12.40,,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,65.04,272,,,fee schedule,272% of BCBS fee schedule,65.04,272,,,fee schedule,272% of BCBS fee schedule,65.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18.6,60,,14.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,65.04,
PRO-BNP N-TERMINAL,17608692,CDM,301,RC,83880,HCPCS,OUTPATIENT,,,129.00,51.60,,31.43,100,,,fee schedule,100% of Aetna fee schedule,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.4,60,,61.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,49.07,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,90.3,70,,72.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,31.43,109.65,
THROMBIN-ANTITHROMBIN (TAT) COMPLEX,17608694,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,21.58,94.35,
O & P SPECIAL STAIN (OVA & PARASITES),17608720,CDM,306,RC,87209,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,22.47,63.75,
ALLERGY INSECT VENOM 1,17608722,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,11.00,4.40,,4.83,100,,,fee schedule,100% of Aetna fee schedule,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,20.16,
ALLERGY INSECT VENOM 2,17608723,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,11.00,4.40,,4.83,100,,,fee schedule,100% of Aetna fee schedule,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,20.16,
ALLERGY INSECT VENOM 3,17608724,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,11.00,4.40,,4.83,100,,,fee schedule,100% of Aetna fee schedule,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,20.16,
ALLERGY INSECT VENOM 4,17608725,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,11.00,4.40,,4.83,100,,,fee schedule,100% of Aetna fee schedule,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,20.16,
ALLERGY INSECT VENOM 5,17608726,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,11.00,4.40,,4.83,100,,,fee schedule,100% of Aetna fee schedule,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,20.16,
ALLERGY SPEC IGE (LIME),17608727,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,10.00,4.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,20.16,
ALLERGY SPEC IGE (GRAPEFRUIT),17608728,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,10.00,4.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,20.16,
VARICELLA ZOSTER ag if,17608729,CDM,306,RC,87290,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
HEP B SURF AB(VACCINE SCREEN),17608792,CDM,302,RC,86706,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.42,42.5,
HBSAB QUANT,17608793,CDM,302,RC,86706,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,40.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,40.36,
ACTIVATED PROTEIN C RESISTANCE,17608809,CDM,305,RC,85307,HCPCS,OUTPATIENT,,,333.00,133.20,,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.8,60,,159.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,233.1,70,,186.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,106.56,32,,85.25,percent of total billed charges,32% of total billed charges,19.15,283.05,
IA-2 ANTIBODY(INSULINOMA ASSOC-2 ANTIBOD,17608888,CDM,302,RC,86341,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,76.38,
".DENGUE FEVER Igg, Igm #2",17608896,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,16.1,60.35,
INSULIN AUTO ANTIBODY,17608899,CDM,302,RC,86337,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,82.66,272,,,fee schedule,272% of BCBS fee schedule,82.66,272,,,fee schedule,272% of BCBS fee schedule,82.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,26.76,82.66,
ACETYLCH RECEPTOR MODULATING ANTIBODY,17608913,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
MANROSE BINDING LECTIN,17608985,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,21.58,85,
INSULIN AUTO ANTI-BODY,17608999,CDM,302,RC,86337,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,82.66,272,,,fee schedule,272% of BCBS fee schedule,82.66,272,,,fee schedule,272% of BCBS fee schedule,82.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,26.76,82.66,
17 OH CORTICOSTERIODS/24UA*REFRIG*,17609019,CDM,301,RC,83491,HCPCS,OUTPATIENT,,,285.00,114.00,,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,67.62,272,,,fee schedule,272% of BCBS fee schedule,67.62,272,,,fee schedule,272% of BCBS fee schedule,67.62,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,171,60,,136.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,199.5,70,,159.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,22.37,242.25,
*T HELPER SUPPESSOR DO NOT USE 082201,17609020,CDM,302,RC,86360,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,58.72,
"VARICELLA ZOSTER VIRUS DNA, QUALIT,REAL",17609022,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,221.00,88.40,,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132.6,60,,106.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,154.7,70,,123.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,43.86,187.85,
CULTURE MYCOPLASMA,17609023,CDM,306,RC,87109,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.38,272,,,fee schedule,272% of BCBS fee schedule,59.38,272,,,fee schedule,272% of BCBS fee schedule,59.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.23,59.5,
BORDETELLA PERTUSSI IGG IGA AB,17609024,CDM,302,RC,86615,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,16.48,50.92,
.BORDETELLA PERTUSSI  IGA AB,17609025,CDM,302,RC,86615,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,16.48,50.92,
.BORDETELLA PERTUSSI IGG AB #2,17609026,CDM,302,RC,86615,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,16.48,50.92,
.BORDETELLA PERTUSSI IGG  AB #3,17609027,CDM,302,RC,86615,HCPCS,OUTPATIENT,,,59.00,23.60,,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,16.48,50.92,
CD4 CD8(IMMUNE DEFIENCY PANEL),17609030,CDM,302,RC,86360,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,58.72,
FERN TEST,17609031,CDM,306,RC,87210,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
LUVOX (FLUVOXAMINE),17609040,CDM,301,RC,80332,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
ZONISAMIDE (ZONEYAN TM),17609045,CDM,301,RC,80203,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,16.56,53.55,
CULTURE LEGIONELLA (C360),17609049,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,8.28,27.2,
..CCP IGG(CYCLIC CITRULLINATED PEPTIDE),17609050,CDM,302,RC,86200,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,16.18,49.3,
ENDOMYSIAL AB SCR W/REFLEX TO TITER,17609051,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
"GLIADIN AB PANEL IgA,IgG",17609052,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
GLIADIN AB PANEL IgA,17609053,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
COCAINE UA INHOUSE,17609054,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,276.00,110.40,,53.87,100,,,fee schedule,100% of Aetna fee schedule,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165.6,60,,132.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,234.6,
OPIATE UA INHOUSE,17609055,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,276.00,110.40,,53.87,100,,,fee schedule,100% of Aetna fee schedule,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165.6,60,,132.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,234.6,
BENZODIAZEPINE UA INHOUSE,17609056,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,180.00,72.00,,53.87,100,,,fee schedule,100% of Aetna fee schedule,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,108,60,,86.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,126,70,,100.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,53.26,153,
BARBITURATE UA INHOUSE,17609057,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,276.00,110.40,,53.87,100,,,fee schedule,100% of Aetna fee schedule,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165.6,60,,132.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,234.6,
AMPHETAMINES UA INHOUSE,17609058,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,276.00,110.40,,53.87,100,,,fee schedule,100% of Aetna fee schedule,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165.6,60,,132.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,234.6,
THC UA INHOUSE,17609059,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,276.00,110.40,,53.87,100,,,fee schedule,100% of Aetna fee schedule,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165.6,60,,132.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,193.2,70,,154.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,88.32,32,,70.66,percent of total billed charges,32% of total billed charges,53.26,234.6,
TOXOCARA,17609060,CDM,302,RC,86682,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.26,51,
ELIS TOXOPLA IGG/IGM GONDI #2,17609061,CDM,302,RC,86777,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,55.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,17.98,56.1,
ELIS TOXOPLA IGM/IGG GONDI #1,17609062,CDM,302,RC,86682,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,16.26,56.1,
"BARTONELLA SPECIES AB IGG,IGM W REFLEX",17609063,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,12.72,40.8,
.BARTONELLA SPECIES #1,17609064,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,12.72,40.8,
.BARTONELLA SPECIES #2,17609065,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,12.72,40.8,
.BARTONELLA SPECIES #3,17609066,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,12.72,40.8,
B. HENSELAE IGM TITER,17609067,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
NON AUTOMATED WO MICROSCOPY,17609068,CDM,301,RC,81002,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.35,11.9,
THC SERUM (MARIJUANA),17609070,CDM,301,RC,80349,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
RITALIN (METHYLPHENIDATE) URINE,17609080,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,82.00,32.80,,53.87,100,,,fee schedule,100% of Aetna fee schedule,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,77.67,
HEALTHCARE BENZODIAZEPINES (PAIN MANGMT),17609085,CDM,307,RC,80346,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,71.4,272,,,fee schedule,272% of BCBS fee schedule,71.4,272,,,fee schedule,272% of BCBS fee schedule,71.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,71.4,
"BENZODIAZEPINES, BY GC/MS,UR",17609086,CDM,307,RC,80154,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
SPECIFIC GRAVITY URINE,17609087,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,9.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.35,11.9,
BF GLUCOSE(BODY FLUID),17609100,CDM,301,RC,82945,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.91,18.7,
SYNOVIAL FLUID(CELL COUNT),17609101,CDM,305,RC,89050,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,5.9,19.55,
SYNOVIAL FLUID(CHLORIDE),17609102,CDM,301,RC,82438,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.25,19.55,
SYNOVIAL FLUID(CRYSTALS),17609103,CDM,301,RC,89060,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,27.61,272,,,fee schedule,272% of BCBS fee schedule,27.61,272,,,fee schedule,272% of BCBS fee schedule,27.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,9.16,28.9,
SYNOVIAL FLUID(TOTAL PROTEIN),17609104,CDM,301,RC,84157,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,5,16.15,
VDRL(CSF FLUID),17609106,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
URIC ACID (BODY FLUID),17609107,CDM,301,RC,84560,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.35,19.55,
CULTURE SYNOVIAL FLUID,17609108,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
.GRAM STAIN(DO NOT ORDER),17609109,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
PLEURAL FLUID(LDH),17609110,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,28.00,11.20,,5.59,100,,,fee schedule,100% of Aetna fee schedule,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,5.59,23.8,
PLEURAL FLUID(GLUCOSE),17609111,CDM,301,RC,82945,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.91,18.7,
PLEURAL FLUID(CELL COUNT),17609112,CDM,305,RC,89050,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,5.9,19.55,
PLEURAL FLUID(CHLORIDE),17609113,CDM,301,RC,82438,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.25,19.55,
PLEURAL FLUID(TOTAL PROTEIN),17609114,CDM,301,RC,84157,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,5,16.15,
PLEURAL FLUID(RA),17609115,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,7.67,22.1,
PLEURAL FLUID(VDRL),17609116,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
CULTURE PLEURAL FLUID,17609117,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
PLEURAL FLUID(GRAM STAIN),17609118,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,30.10,12.04,,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18.06,60,,14.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,25.59,85,,20.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,21.07,70,,16.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,5.33,25.59,
CSF GLUCOSE  (REFERENCE),17609119,CDM,301,RC,82945,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.91,18.7,
CSF(CHLORIDE),17609120,CDM,301,RC,82438,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,6.25,45.9,
CSF(TOTAL PROTEIN) REFERENCE,17609121,CDM,301,RC,84157,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,5,16.15,
CSF(RA),17609122,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,7.67,22.1,
CSF(VDRL),17609123,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
BF CULTURE BODY FLUIDS,17609124,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
CSF(GRAM STAIN),17609125,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,30.10,12.04,,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18.06,60,,14.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,25.59,85,,20.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,21.07,70,,16.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,5.33,25.59,
CSF(LDH),17609127,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,28.00,11.20,,5.59,100,,,fee schedule,100% of Aetna fee schedule,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,5.59,23.8,
PERITONEAL FLUID(LDH),17609128,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,28.00,11.20,,5.59,100,,,fee schedule,100% of Aetna fee schedule,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,5.59,23.8,
PERITONEAL FLUID(GLUCOSE),17609129,CDM,301,RC,82945,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.91,18.7,
PERITONEAL FLUID(CELL COUNT),17609130,CDM,305,RC,89050,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,18.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,5.9,19.55,
PERITONEAL FLUID(CHLORIDE),17609131,CDM,301,RC,82438,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,18.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.25,19.55,
PERITONEAL FLUID(TOTAL PROTEIN),17609132,CDM,301,RC,84157,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,5,16.15,
PERITONEAL FLUID(RA),17609133,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,7.67,22.1,
PERITONEAL FLUID(VDRL),17609134,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,5.33,17.85,
CULTURE PERITONEAL FLUID,17609135,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
PERITONEAL FLUID(GRAM STAIN),17609136,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,30.10,12.04,,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18.06,60,,14.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,25.59,85,,20.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,21.07,70,,16.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,9.63,32,,7.7,percent of total billed charges,32% of total billed charges,5.33,25.59,
LDH (BODY FLUIDS),17609137,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,28.00,11.20,,5.59,100,,,fee schedule,100% of Aetna fee schedule,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,23.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,5.59,23.8,
ANTI-RETICULIN IGA,17609139,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
ANTI-RETICULIN IGA TITER,17609140,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
ANTI-ENDOMESTIAL ANTIBODY SCREEN,17609141,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.99,
ANTI-ENDOMESTIAL ANTIBODY TITERN,17609142,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.99,
VAP CHOLESTEROL TEST,17609204,CDM,301,RC,83701,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,46.54,
HBCAB (HEPATITIS B CORE AB),17609346,CDM,302,RC,86705,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,44.25,272,,,fee schedule,272% of BCBS fee schedule,44.25,272,,,fee schedule,272% of BCBS fee schedule,44.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,14.71,45.9,
DAU-8-THC (RAPID DRUG TEST),17609347,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DAU-8-OPIATES(RAPID DRUG TEST),17609348,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DAU-8-COCAINE(RAPID DRUG TEST),17609349,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DAU-8-METHAMPHETAMINE(RAPID DRUG TEST),17609350,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DAU-8-BENZODIAZEPINES(RAPID DRUG TEST),17609351,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DAU-8-BARBITURATES(RAPID DRUG TEST),17609352,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DAU-8-TCAs(RAPID DRUG TEST),17609353,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DAU-8-phencyclidine(RAPID DRUG TEST),17609354,CDM,301,RC,80100,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
NUCLEIC ACID ISOLATION,17609355,CDM,301,RC,83891,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
HEALTHCARE OPIATE (PAIN MANAGEMENT),17609555,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
INFLUENZA A & B #2,17609571,CDM,306,RC,87804,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
FACTOR X1,17609572,CDM,305,RC,85270,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,22.37,69.12,
PROTHROMBIN GENE ANALYSIS,17609573,CDM,310,RC,81240,HCPCS,OUTPATIENT,,,476.00,190.40,,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.6,60,,228.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,82.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,404.6,85,,323.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,333.2,70,,266.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,152.32,32,,121.86,percent of total billed charges,32% of total billed charges,82.11,404.6,
KLONOPIN,17609672,CDM,301,RC,80306,HCPCS,OUTPATIENT,,,97.00,38.80,,13.47,100,,,fee schedule,100% of Aetna fee schedule,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,13.47,82.45,
FACTOR VIII,17609752,CDM,305,RC,85240,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,69.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,22.37,69.12,
D-DIMER ASSAY,17609824,CDM,305,RC,85379,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.28,272,,,fee schedule,272% of BCBS fee schedule,39.28,272,,,fee schedule,272% of BCBS fee schedule,39.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.72,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,12.72,103.7,
HYDROXYPROLINE FREE (24HR URINE),17609831,CDM,301,RC,83500,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,85.33,272,,,fee schedule,272% of BCBS fee schedule,85.33,272,,,fee schedule,272% of BCBS fee schedule,85.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,28.31,93.5,
DIPHENHYDRAMINE,17609836,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,23.3,67.15,
HIV RNA QUANT bDNA,17609837,CDM,306,RC,87799,HCPCS,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,53.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,53.55,266.9,
WET PREP & KOH,17609871,CDM,306,RC,87210,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,16.48,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.27,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
.BENZODIAZEPINES (URINE),17609872,CDM,307,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
CLONIDINE (S/P),17609873,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
LUPUS(SLE)PANEL,17609875,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,56.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,56.17,
UREA-NITROGEN (24HR URINE),17609878,CDM,301,RC,84545,HCPCS,OUTPATIENT,,,39.32,15.73,,,,,,other ,not seperately reimbursable,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,25.49,272,,,fee schedule,272% of BCBS fee schedule,25.49,272,,,fee schedule,272% of BCBS fee schedule,25.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.59,60,,18.87,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,33.42,85,,26.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,27.52,70,,22.02,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,12.58,32,,10.06,percent of total billed charges,32% of total billed charges,9,33.42,
CSF GLUCOSE,17609911,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.15,272,,,fee schedule,272% of BCBS fee schedule,15.15,272,,,fee schedule,272% of BCBS fee schedule,15.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,4.91,18.7,
BB FFP THAWING / UNIT,17609925,CDM,300,RC,86927,HCPCS,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
PREGABALIN (LYRICIA),17609980,CDM,300,RC,80299,HCPCS,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,23.3,95.2,
URINE CYTOLOGY,17609987,CDM,302,RC,88304,HCPCS,OUTPATIENT,,,55.00,22.00,,36.86,100,,,fee schedule,100% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.24,272,,,fee schedule,272% of BCBS fee schedule,46.24,272,,,fee schedule,272% of BCBS fee schedule,46.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
GLUMATIC ACID DECARBOXYLASE-65 ANTIBODY,17609988,CDM,301,RC,86341,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,76.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,29.46,80.75,
RITUXAN SENSITIVITY ( CD20),17609999,CDM,302,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
ANTIENDOMYSIAL ANTIBODIES,17610025,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15.06,46.75,
HEPATITIS B GENOTYPE,17610529,CDM,306,RC,87912,HCPCS,OUTPATIENT,,,1188.00,475.20,,,,,,other ,not seperately reimbursable,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,712.8,60,,570.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,321.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,1009.8,85,,807.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,831.6,70,,665.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,380.16,32,,304.13,percent of total billed charges,32% of total billed charges,321.81,1009.8,
APOE GENOTYPE ANALYSIS,17611013,CDM,310,RC,81401,HCPCS,OUTPATIENT,,,1146.00,458.40,,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,687.6,60,,550.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,171.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,974.1,85,,779.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,802.2,70,,641.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,171.25,974.1,
19911A>MUTATION ANALYSIS,17616533,CDM,310,RC,81400,HCPCS,OUTPATIENT,,,897.00,358.80,,,,,,other ,not seperately reimbursable,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,538.2,60,,430.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,627.9,70,,502.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,287.04,32,,229.63,percent of total billed charges,32% of total billed charges,79.95,762.45,
MTHFR  Methylenetetrahydrofolate Reducta,17617911,CDM,310,RC,81291,HCPCS,OUTPATIENT,,,894.00,357.60,,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,536.4,60,,429.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,81.67,759.9,
MICROALBUMIN (24HR URINE)(REFERENCE),17618035,CDM,301,RC,82043,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,6.61,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.22,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,6.61,45.9,
"INTERLEUKIN-6,HIGHLY SENSITIVE, ELISA",17618854,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,188.00,75.20,,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,112.8,60,,90.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,21.58,159.8,
"NOROVIRUS RNA,QUAL REAL-TIME PCR",17619098,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,235.00,94.00,,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,141,60,,112.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,164.5,70,,131.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,43.86,199.75,
PSILOCYBIN (MUSHROOMS),17633373,CDM,301,RC,83789,HCPCS,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,30.13,233.75,
PROTEINASE-3 ANTIBODY,17634151,CDM,302,RC,86021,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,18.81,85,
"CRYOGLOBULIN SCREEN,REF TO CRY PROFILE",17637358,CDM,301,RC,82595,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.08,25,
C DIFFICULE TOX B QUALITAVE BY PCR,17639478,CDM,306,RC,87493,HCPCS,OUTPATIENT,,,123.00,49.20,,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.8,60,,59.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,104.55,
ACTIN ANTIBODIES,17655982,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,14.41,44.55,
NUCLEAR ANTIGEN ANTIBODY,17658623,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
XANAX,17660101,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
. DHEA,17660178,CDM,301,RC,82626,HCPCS,OUTPATIENT,,,159.00,63.60,,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,97.57,272,,,fee schedule,272% of BCBS fee schedule,97.57,272,,,fee schedule,272% of BCBS fee schedule,97.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,95.4,60,,76.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,111.3,70,,89.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,31.58,135.15,
DHEA-S(DEHYDEOEPLANDROSTERONE SULFATE),17660179,CDM,301,RC,82627,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,85.84,272,,,fee schedule,272% of BCBS fee schedule,85.84,272,,,fee schedule,272% of BCBS fee schedule,85.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,27.78,85.84,
RAST D.PTERONTSSINUS(MITES),17660180,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST DERM FARINAE(MITES),17660181,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST CAT DANDER,17660182,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST DOG EPITHELIUMUS(MITES),17660183,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST COCKROACH,17660184,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST PENICILLIUM NOTATUM,17660185,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST CLADOSPORIUM HERBARUM,17660186,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST ASPERGILLUS FUMIGATUS,17660187,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST ALTERNARIS TENUIS,17660188,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST SYCAMORE,17660189,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST ENGLISH PLANTAIN,17660190,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST COTTON WOOD,17660191,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
RAST JOHNSON GRASS,17660192,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
PREGABLIN (LYRICA),17661084,CDM,301,RC,80366,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
HTLV I,17661086,CDM,302,RC,86687,HCPCS,OUTPATIENT,,,44.25,17.70,,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,32.4,272,,,fee schedule,272% of BCBS fee schedule,32.4,272,,,fee schedule,272% of BCBS fee schedule,32.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,26.55,60,,21.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,37.61,85,,30.09,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,30.98,70,,24.78,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,11.36,37.61,
HTLV II,17661087,CDM,302,RC,86688,HCPCS,OUTPATIENT,,,44.25,17.70,,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,54.1,272,,,fee schedule,272% of BCBS fee schedule,54.1,272,,,fee schedule,272% of BCBS fee schedule,54.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,26.55,60,,21.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,37.61,85,,30.09,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,30.98,70,,24.78,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,14.16,32,,11.33,percent of total billed charges,32% of total billed charges,14.16,54.1,
MUSK AB TITER,17661088,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,735.00,294.00,,,,,,other ,not seperately reimbursable,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,441,60,,352.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,624.75,85,,499.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,514.5,70,,411.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,235.2,32,,188.16,percent of total billed charges,32% of total billed charges,23,624.75,
H-PYLORI IgG AB,17665981,CDM,302,RC,86677,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.06,56.1,
WESTERN EQUINE ENCEPH IGM,17665982,CDM,302,RC,86653,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
CALIFORNIA ENCEPH AB IGG,17665983,CDM,302,RC,86651,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
CALIFORNIA ENCEPH AB IGM,17665984,CDM,302,RC,86651,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
EASTERN EQUINE ENCEPH IGM,17665985,CDM,302,RC,86652,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
EASTERN EQUINE ENCEPH  CSF,17665986,CDM,302,RC,86652,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
ST LOUIS ENCEPH IGG,17665987,CDM,302,RC,86653,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
ST LOUIS ENCEPH IGM,17665988,CDM,302,RC,86653,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
WESTERN EQUINE ENCEPH IGG,17665989,CDM,302,RC,86653,HCPCS,OUTPATIENT,,,39.25,15.70,,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,50.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,23.55,60,,18.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,33.36,85,,26.69,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,27.48,70,,21.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,32,,10.05,percent of total billed charges,32% of total billed charges,12.56,50.92,
BATH SALTS (SYNTHETIC STIMULANTS),17668011,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
ULTRAM,17668029,CDM,301,RC,80373,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
CORONOVIRUS 2 AB QUAL/SEMI-QUAL,17668903,CDM,301,RC,86328,HCPCS,OUTPATIENT,,,58.65,23.46,,,,,,other ,not seperately reimbursable,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.19,60,,28.15,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,56.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,49.85,85,,39.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,41.06,70,,32.85,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,18.77,32,,15.02,percent of total billed charges,32% of total billed charges,18.77,56.6,
SPEC COLLECT SARS COV 2 ANY SOURCE,17668904,CDM,300,RC,C9803,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
SPEC COLLECT SARS COV 2 ANY SRCE SNF,17668905,CDM,300,RC,C9803,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
GAMMA-HYDROXYBUTYRIC ACID SCREEN URINE,17680100,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
LSD PRESUMPTIVE SCREEN (URINE),17680101,CDM,301,RC,80101,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
TRAMADOL QNT (URINE),17680102,CDM,301,RC,80373,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
CARBAMAZEPINE free,17680157,CDM,301,RC,80157,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,16.56,60.35,
LITHIUM URINE,17680178,CDM,301,RC,80178,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,25.51,272,,,fee schedule,272% of BCBS fee schedule,25.51,272,,,fee schedule,272% of BCBS fee schedule,25.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,8.26,46.75,
"BB RBC, STORAGE FEE",17680211,CDM,390,RC,P9021,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
"*BB PLATELETS,STORAGE FEE",17680212,CDM,390,RC,P9019,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,119.68,272,,,fee schedule,272% of BCBS fee schedule,119.68,272,,,fee schedule,272% of BCBS fee schedule,119.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
*BB FRESH FROZEN PLASMA STORE FEE,17680214,CDM,390,RC,P9017,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,122.4,272,,,fee schedule,272% of BCBS fee schedule,122.4,272,,,fee schedule,272% of BCBS fee schedule,122.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
"*BB  PLASMA,POOLED STORAGE FEE",17680221,CDM,390,RC,P9023,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
"*BB PLATELETS,APHERESIS STORAGE FEE",17680223,CDM,390,RC,P9034,HCPCS,OUTPATIENT,,,675.00,270.00,,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405,60,,324,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,472.5,70,,378,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,32,,172.8,percent of total billed charges,32% of total billed charges,216,573.75,
"*BB PLATELETS,LEUKOCYTES STORAGE FEE",17680224,CDM,390,RC,P9031,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
"ABILIFY (ARIPIPRAZOLE, QUANT)",17680299,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,23.3,96.05,
UNLISTED MOLECULAR PATH PROCEDURE,17681479,CDM,310,RC,81479,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
ALUMINUM LEVEL,17682108,CDM,301,RC,82108,HCPCS,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,98.38,272,,,fee schedule,272% of BCBS fee schedule,98.38,272,,,fee schedule,272% of BCBS fee schedule,98.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,31.85,98.38,
MDMA & METABOLITE RANDOM URINE,17682145,CDM,301,RC,82145,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
AMYLASE ISOENZYME,17682150,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,25.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,8.1,59.5,
"ARSENIC URINE, 24 HOUR",17682175,CDM,301,RC,82175,HCPCS,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,73.25,272,,,fee schedule,272% of BCBS fee schedule,73.25,272,,,fee schedule,272% of BCBS fee schedule,73.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,23.71,115.6,
.TSH RECEPTOR ANTIBODY,17682397,CDM,301,RC,82397,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,17.65,85,
DOPAMINE 24 HR URINE,17682491,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,74.00,29.60,,17.37,100,,,fee schedule,100% of Aetna fee schedule,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,17.37,65.52,
C-TELOPEPTIDE (CTX) COLLagen type 1,17682523,CDM,301,RC,82523,HCPCS,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,23.35,126.65,
ACTH STIMULATION (3 SPECIMENS),17682533,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,62.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,20.37,62.94,
"SMITH-LEMIL-OPITZ SCREEN, PLASMA",17682541,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,74.00,29.60,,17.37,100,,,fee schedule,100% of Aetna fee schedule,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,17.37,65.52,
ARIPRPRAZOLE (ABILIFY),17682542,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
CYSTAIN C,17682610,CDM,301,RC,82610,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
DIHYDROTESTOSTERONE,17682651,CDM,301,RC,82651,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
ESTRONE,17682679,CDM,301,RC,82679,HCPCS,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,96.37,272,,,fee schedule,272% of BCBS fee schedule,96.37,272,,,fee schedule,272% of BCBS fee schedule,96.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,31.18,96.37,
COBALT,17683011,CDM,302,RC,83018,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,84.78,
UREA BREATH TEST H-PYLORI,17683013,CDM,302,RC,83013,HCPCS,OUTPATIENT,,,273.00,109.20,,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,241.54,272,,,fee schedule,272% of BCBS fee schedule,241.54,272,,,fee schedule,272% of BCBS fee schedule,241.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,163.8,60,,131.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,84.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,191.1,70,,152.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,84.2,241.54,
MOLYBDENUM,17683018,CDM,302,RC,83018,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,84.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,84.78,
HOMOCYSTEINE CARDIAC,17683090,CDM,301,RC,83090,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,22.4,85,
"IMMUNOASSAY,NONANTIBODY",17683516,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,14.41,68.85,
TSH ANTIBODY,17683519,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23,80.75,
ANTI-MULLERIAN HORMONE ASSESS (TM),17683520,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,49.99,
IGE ANTIBODY (ANTI IGE IGG),17683521,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,49.99,
MANGANESE,17683785,CDM,301,RC,83785,HCPCS,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,94.93,272,,,fee schedule,272% of BCBS fee schedule,94.93,272,,,fee schedule,272% of BCBS fee schedule,94.93,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,94.93,
ZOLIPIDEM,17683788,CDM,301,RC,80368,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
THIOPURINE METHYLTRANSFERASE (TPMT),17683789,CDM,301,RC,81335,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,218.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,218.51,
MERCURY URINE,17683825,CDM,301,RC,83825,HCPCS,OUTPATIENT,,,114.40,45.76,,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,62.75,272,,,fee schedule,272% of BCBS fee schedule,62.75,272,,,fee schedule,272% of BCBS fee schedule,62.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,68.64,60,,54.91,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,97.24,85,,77.79,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,80.08,70,,64.06,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,36.61,32,,29.29,percent of total billed charges,32% of total billed charges,20.32,97.24,
METANEPHRINES(RANDOM URINE),17683835,CDM,301,RC,83835,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,65.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,21.17,68.85,
"PAIN MANAGEMENT, METHADONE,QUANT, URINE",17683840,CDM,301,RC,83840,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
FREE KAPPA & LAMBA #1,17683883,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,70.00,28.00,59,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,17,59.5,
.FREE KAPPA & LAMBA #2,17683884,CDM,301,RC,83883,HCPCS,OUTPATIENT,,,63.00,25.20,59,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,52.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,17,53.55,
PREGNENOLONE,17683885,CDM,301,RC,84140,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.29,272,,,fee schedule,272% of BCBS fee schedule,63.29,272,,,fee schedule,272% of BCBS fee schedule,63.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,25.83,77.35,
LEPTIN,17683886,CDM,301,RC,82397,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,17.65,63.75,
NICOTINE & metabolite (blood),17683887,CDM,301,RC,80323,HCPCS,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,93.32,272,,,fee schedule,272% of BCBS fee schedule,93.32,272,,,fee schedule,272% of BCBS fee schedule,93.32,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,93.32,
AFP AND AFP-L3,17683888,CDM,301,RC,82107,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,80.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,80.51,
DRUG ABUSE PANEL 10 SERUM,17683889,CDM,301,RC,80306,HCPCS,OUTPATIENT,,,210.00,84.00,,13.47,100,,,fee schedule,100% of Aetna fee schedule,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,126,60,,100.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,147,70,,117.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,13.47,178.5,
PAIN MANAGMENT PROF.1 W/CONF,17683890,CDM,301,RC,80306,HCPCS,OUTPATIENT,,,177.00,70.80,,13.47,100,,,fee schedule,100% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,13.47,150.45,
MOLECULAR isolate nucleic,17683891,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
"AMPLIFICATION, TARGET,MULTIPLEX,1ST 2 NA",17683900,CDM,302,RC,83900,HCPCS,OUTPATIENT,,,143.00,57.20,,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.8,60,,68.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,100.1,70,,80.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,121.55,
LYSE CELLS FOR NUC EXT,17683907,CDM,302,RC,83907,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
GENETIC EXAMINATION,17683912,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
MAGNESIUM(IN-HOUSE),17683913,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,43.00,17.20,,6.2,100,,,fee schedule,100% of Aetna fee schedule,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,25.87,272,,,fee schedule,272% of BCBS fee schedule,25.87,272,,,fee schedule,272% of BCBS fee schedule,25.87,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,6.2,36.55,
Mutation ident ola/sbce/aspe,17683914,CDM,310,RC,83914,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
OXI,17683925,CDM,301,RC,83925,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
"CALPROTECTIN, STOOL",17683993,CDM,301,RC,83993,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,24.53,68,
PAPPA SERUM,17684163,CDM,301,RC,84163,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,18.81,90.1,
SELENIUM,17684255,CDM,301,RC,84255,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,98.57,272,,,fee schedule,272% of BCBS fee schedule,98.57,272,,,fee schedule,272% of BCBS fee schedule,98.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,31.91,98.57,
POTASSIUM(FECES),17684311,CDM,301,RC,84311,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,10.12,42.5,
"FECAL BILE, QUAL",17684321,CDM,301,RC,84311,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,27.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,27.01,
BF URIC ACID (SYNOVIAL),17684560,CDM,301,RC,84560,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,18.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,6.35,19.55,
VITAMIN K,17684597,CDM,301,RC,84597,HCPCS,OUTPATIENT,,,250.00,100.00,,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,26.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,17.15,212.5,
BIOTIN (VITAMIN B7),17684598,CDM,301,RC,84591,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,21.32,76.5,
CHORIONIC GOGADOTROPIN,17684702,CDM,301,RC,84702,HCPCS,OUTPATIENT,,,106.00,42.40,,13.94,100,,,fee schedule,100% of Aetna fee schedule,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,13.94,90.1,
PERIPHERAL SMEAR,17685060,CDM,305,RC,85060,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
PROTEIN C  AG,17685302,CDM,305,RC,85302,HCPCS,OUTPATIENT,,,146.22,58.49,,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,46.4,272,,,fee schedule,272% of BCBS fee schedule,46.4,272,,,fee schedule,272% of BCBS fee schedule,46.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,87.73,60,,70.18,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,124.29,85,,99.43,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,102.35,70,,81.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,15.01,124.29,
PROTEIN S AG,17685305,CDM,305,RC,85305,HCPCS,OUTPATIENT,,,146.22,58.49,,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,44.74,272,,,fee schedule,272% of BCBS fee schedule,44.74,272,,,fee schedule,272% of BCBS fee schedule,44.74,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,87.73,60,,70.18,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,124.29,85,,99.43,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,102.35,70,,81.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,46.79,32,,37.43,percent of total billed charges,32% of total billed charges,14.51,124.29,
PLASMINOGEN ACTIVATOR INHIBITOR(PAI-1),17685415,CDM,305,RC,85415,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,35.66,
HEXAGONAL PHASE CONFIRM,17685597,CDM,305,RC,85598,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
RAST RICE,17686003,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,25.00,10.00,,4.83,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,20.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,4.83,21.25,
"ANTIBODY ID, LEVKOCYTE ANTBODIES",17686021,CDM,302,RC,86021,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,57.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,18.81,57.8,
.ANA IFA W/REFLEX TO TIER/PATT/CASCADE,17686038,CDM,302,RC,86038,HCPCS,OUTPATIENT,,,69.00,27.60,,11.19,100,,,fee schedule,100% of Aetna fee schedule,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,46.65,272,,,fee schedule,272% of BCBS fee schedule,46.65,272,,,fee schedule,272% of BCBS fee schedule,46.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,11.19,58.65,
.ANA TITER/PATTERN,17686039,CDM,302,RC,86039,HCPCS,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,43.11,272,,,fee schedule,272% of BCBS fee schedule,43.11,272,,,fee schedule,272% of BCBS fee schedule,43.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,13.95,43.11,
ALPHA-1-ANTITRYPSIN MUTATION,17686040,CDM,310,RC,81332,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,54.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
"COMPLEMENT, ANTIGEN",17686160,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,15,46.75,
COMPLEMENT COMPONENT CIQ,17686161,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,46.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,46.35,
ss DNA(SINGLE STRAND DNA) IgG AB,17686226,CDM,302,RC,86226,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,46.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,15.13,46.73,
SMITH (SM)  ANTIBODY,17686235,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,69.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,22.41,80.75,
FLUOR ANTIBODY SCREEN,17686255,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,15.06,72.25,
"HE4, OVARIAN CANCER MONITORING",17686305,CDM,302,RC,86305,HCPCS,OUTPATIENT,,,256.00,102.40,,,,,,other ,not seperately reimbursable,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.6,60,,122.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,217.6,85,,174.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,179.2,70,,143.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,81.92,32,,65.54,percent of total billed charges,32% of total billed charges,26.01,217.6,
IMMUNOASSAY TUMOR OTHER,17686316,CDM,302,RC,86316,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,26.01,76.68,
RABIES VACCINE RESPONSE,17686317,CDM,302,RC,86317,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,57.88,272,,,fee schedule,272% of BCBS fee schedule,57.88,272,,,fee schedule,272% of BCBS fee schedule,57.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,18.73,59.5,
IMMUNE CELL FUNCTION,17686352,CDM,302,RC,86353,HCPCS,OUTPATIENT,,,765.00,306.00,,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,189.26,272,,,fee schedule,272% of BCBS fee schedule,189.26,272,,,fee schedule,272% of BCBS fee schedule,189.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,459,60,,367.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,650.25,85,,520.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,535.5,70,,428.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,244.8,32,,195.84,percent of total billed charges,32% of total billed charges,61.28,650.25,
MONONUCLEAR CELL ANTIGEN,17686356,CDM,302,RC,86356,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
HBs Ab QUANTATIVE TITER,17686377,CDM,302,RC,86317,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,57.88,272,,,fee schedule,272% of BCBS fee schedule,57.88,272,,,fee schedule,272% of BCBS fee schedule,57.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,18.73,62.9,
"RHEUMATOID FACTOR, QUANT",17686431,CDM,302,RC,86431,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.08,21.92,
ADENOVIRUS Ab,17686603,CDM,302,RC,86603,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,49.69,272,,,fee schedule,272% of BCBS fee schedule,49.69,272,,,fee schedule,272% of BCBS fee schedule,49.69,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.08,49.69,
BLASTOMYCES ANTIBODY,17686612,CDM,302,RC,86612,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,49.83,272,,,fee schedule,272% of BCBS fee schedule,49.83,272,,,fee schedule,272% of BCBS fee schedule,49.83,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.12,49.83,
LYME DISEASE ANTIBODY(IGM) WESTERN BLOT,17686617,CDM,302,RC,86617,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,59.79,272,,,fee schedule,272% of BCBS fee schedule,59.79,272,,,fee schedule,272% of BCBS fee schedule,59.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,19.36,103.7,
"CAMPYLOBACTER  AB, ELISA",17686625,CDM,302,RC,86625,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,50.65,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,16.4,63.75,
SACCHAROMYCES CEREVISIAE ASCA AB,17686671,CDM,302,RC,86671,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,47.33,272,,,fee schedule,272% of BCBS fee schedule,47.33,272,,,fee schedule,272% of BCBS fee schedule,47.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,15.31,85,
H-PYLORI IGA,17686677,CDM,302,RC,86677,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,56.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.06,56.1,
STRONGYLOIDES ANTIBODIES,17686682,CDM,302,RC,86682,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.26,50.21,
HIV-1 WESTERN BLOT PROGRESSIVE,17686689,CDM,302,RC,86689,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,74.72,272,,,fee schedule,272% of BCBS fee schedule,74.72,272,,,fee schedule,272% of BCBS fee schedule,74.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,24.18,74.72,
"HEP D VIRUS (HDV) IGM ANTIBODY,EIA",17686692,CDM,302,RC,86692,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,66.26,272,,,fee schedule,272% of BCBS fee schedule,66.26,272,,,fee schedule,272% of BCBS fee schedule,66.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,21.45,66.26,
HISTOPLASMA ANTIBODY,17686698,CDM,302,RC,86698,HCPCS,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,48.28,272,,,fee schedule,272% of BCBS fee schedule,48.28,272,,,fee schedule,272% of BCBS fee schedule,48.28,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,48.28,
"HIV-2 AB,EIA W/REFLEX TO IMMUNOBLOT",17686702,CDM,302,RC,86702,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,52.2,272,,,fee schedule,272% of BCBS fee schedule,52.2,272,,,fee schedule,272% of BCBS fee schedule,52.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,16.9,52.2,
"HERPES VIRUS 6 AB IgG, IgM #1",17686790,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,16.1,60.35,
".CRYPTOSPORDIUM ANTIGEN, DFA #1",17687015,CDM,306,RC,87015,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.35,25.79,
CULTURE BLOOD PEDS,17687040,CDM,306,RC,87040,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,39.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,12.9,60.35,
YERSINIA (STOOL),17687046,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,11.8,34,
VIBRIO CULTURE,17687047,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
OXYCODONE W/METAB,17687048,CDM,300,RC,80365,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
CULTURE CSF,17687070,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,40.00,16.00,,7.98,100,,,fee schedule,100% of Aetna fee schedule,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,33.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,7.98,34,
MRSA SCREEN,17687081,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,25.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,8.28,25.6,
MYCOPLASMA HOMINIS/UREAPLASMA CULTURE,17687109,CDM,306,RC,87109,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.38,272,,,fee schedule,272% of BCBS fee schedule,59.38,272,,,fee schedule,272% of BCBS fee schedule,59.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,19.23,59.5,
MYCOBACTERIAL ID,17687118,CDM,306,RC,87118,HCPCS,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,42.24,272,,,fee schedule,272% of BCBS fee schedule,42.24,272,,,fee schedule,272% of BCBS fee schedule,42.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,42.24,
HERPES SIMPLEX TYPING,17687140,CDM,306,RC,87140,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,21.54,272,,,fee schedule,272% of BCBS fee schedule,21.54,272,,,fee schedule,272% of BCBS fee schedule,21.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,6.96,21.54,
ANAEROBE E-TEST PROFILE,17687181,CDM,306,RC,87181,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ANAEROBE E-TEST PROFILE #2,17687182,CDM,306,RC,87181,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ANAEROBE E-TEST PROFILE #3,17687183,CDM,306,RC,87181,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ANAEROBE E-TEST PROFILE #4,17687184,CDM,306,RC,87181,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,3.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ANTIBODY DETECTION NOS if,17687209,CDM,306,RC,87299,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
".CRYPTOSPORDIUM ANTIGEN, DFA #2",17687272,CDM,306,RC,87015,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,25.79,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,8.35,40.8,
ANTIBODY DETECTION NOS if,17687299,CDM,306,RC,87299,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.12,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
ASPERGILLUS ANTIGEN,17687305,CDM,306,RC,87305,HCPCS,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,14.97,89.25,
ENTAMOEBA HISTOLYTICA Ag EIA,17687337,CDM,306,RC,87337,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,14.97,72.25,
"**CHLAMYDIA PNEUMONIAL, AMP PROBE TECH",17687486,CDM,306,RC,87486,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
"CHLAMYDIA-GC,RNA,TMA,THROAT",17687491,CDM,306,RC,87491,HCPCS,OUTPATIENT,,,118.00,47.20,,32.5,100,,,fee schedule,100% of Aetna fee schedule,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,32.5,100.3,
"**CLOSTRIDIUM DIFFICILE, TOXIN GENE AMP",17687493,CDM,306,RC,87493,HCPCS,OUTPATIENT,,,123.00,49.20,,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.8,60,,59.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,86.1,70,,68.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,32,,31.49,percent of total billed charges,32% of total billed charges,39.36,104.55,
"ENTEROVIRUS RNA, QUALITATIVE REAL TIME P",17687498,CDM,306,RC,87498,HCPCS,OUTPATIENT,,,341.00,136.40,,,,,,other ,not seperately reimbursable,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.6,60,,163.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,238.7,70,,190.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,109.12,32,,87.3,percent of total billed charges,32% of total billed charges,43.86,289.85,
COVID-19 (SARS-COV-2/2019-NCOV),17687501,CDM,300,RC,87635,HCPCS,OUTPATIENT,,,225.00,90.00,QW,51.31,100,,,fee schedule,100% of Aetna fee schedule,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135,60,,108,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.13,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,157.5,70,,126,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,51.31,191.25,
**INFLUENZA VIRUS /MULTI TYPES OR SUB,17687502,CDM,306,RC,87502,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,119.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,119.75,
**INFLUENZA VIRUS /MULTI TYPES OR SUB,17687503,CDM,306,RC,87503,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.52,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
SPEC COLL COVID-19 (SARS-COV-2) ANY SORC,17687504,CDM,300,RC,C9803,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
"**LEGIONELLA PNEUMOPHILA, AMP PROBE TECH",17687541,CDM,306,RC,87541,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
"**MYCOPLASMA PNEUMONIAL, AMP PROBE TECH",17687581,CDM,306,RC,87581,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
N.GONORRHOEAE DNA AMP PROB,17687591,CDM,306,RC,87591,HCPCS,OUTPATIENT,,,122.00,48.80,,32.5,100,,,fee schedule,100% of Aetna fee schedule,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,32.5,103.7,
"**STAPH AVREVS, METHICILLIN RESIST, AMP",17687641,CDM,306,RC,87641,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
"**STREP GROUP A, AMP PROBE TECH",17687651,CDM,306,RC,87651,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
"TRICHOMONOS VAG RNA, QUALITATIVE TMA",17687661,CDM,306,RC,87661,HCPCS,OUTPATIENT,,,144.00,57.60,,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,60,,69.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,43.86,122.4,
"**AMPLIFIED PROBE TECH, EA ORGANISM",17687798,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,112.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,112.06,
"*PHENOTYPE,INFECT AGENT DRUG",17687900,CDM,306,RC,87900,HCPCS,OUTPATIENT,,,550.00,220.00,,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330,60,,264,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,162.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,467.5,85,,374,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,385,70,,308,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,176,32,,140.8,percent of total billed charges,32% of total billed charges,176,32,,140.8,percent of total billed charges,32% of total billed charges,162.93,467.5,
"HCV GENOTYPE, LiPA",17687902,CDM,306,RC,87902,HCPCS,OUTPATIENT,,,1066.00,426.40,,,,,,other ,not seperately reimbursable,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,639.6,60,,511.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,321.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,906.1,85,,724.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,746.2,70,,596.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,341.12,32,,272.9,percent of total billed charges,32% of total billed charges,321.81,906.1,
FLOW CYTOMETRY 1ST MARKER,17688185,CDM,305,RC,88184,HCPCS,OUTPATIENT,,,484.00,193.60,,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,81.66,411.4,
FLOW CYTOMETRY EA ADD'L MARKER,17688189,CDM,305,RC,88185,HCPCS,OUTPATIENT,,,25.00,10.00,,27.64,100,,,fee schedule,100% of Aetna fee schedule,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,27.64,
ANTI-XA,17688190,CDM,305,RC,85520,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,35.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,35.66,
1ST TRIMESTER SCRN HhCG,17688239,CDM,301,RC,82397,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,17.65,85,
IMMUNOFLUORESCENT STUDY,17688347,CDM,301,RC,88350,HCPCS,OUTPATIENT,,,220.00,88.00,,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,187,
PREPPF ARRAY-BASED EVALUATION 51-250PROB,17688385,CDM,302,RC,88385,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
SCHISTOSOMA IgG ANTIBODY FMI (SERUM),17688682,CDM,302,RC,86682,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,50.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,16.26,51,
SYNTHETIC CANNABINOID EXPANDED URINE,17688788,CDM,301,RC,80352,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
"SYNTHETIC CANNABINOIDS, QUAL, SERUM",17688789,CDM,300,RC,80352,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
".MTHFR, DNA(METHYLENETRAHYDROFOLATE REDU",17689976,CDM,310,RC,81291,HCPCS,OUTPATIENT,,,894.00,357.60,,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,536.4,60,,429.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,81.67,759.9,
NMO-IgG AUTOANTIBODIES,17690382,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,407.00,162.80,,,,,,other ,not seperately reimbursable,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,244.2,60,,195.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,284.9,70,,227.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,130.24,32,,104.19,percent of total billed charges,32% of total billed charges,14.41,345.95,
CROHN'S PROGNOSTIC PANEL,17690808,CDM,310,RC,81479,HCPCS,OUTPATIENT,,,655.00,262.00,,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393,60,,314.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,458.5,70,,366.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,32,,167.68,percent of total billed charges,32% of total billed charges,209.6,556.75,
RITALIN (METHYLPHENIDATE) URINE,17690809,CDM,301,RC,82542,HCPCS,OUTPATIENT,,,82.00,32.80,,17.37,100,,,fee schedule,100% of Aetna fee schedule,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,65.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,17.37,69.7,
ANTIGLOMERULAR BASEMENT MEMB ANTIBDY IgG,17698787,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.99,
"HISTONE AB, QUAL",17698788,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,44.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,14.41,51.85,
FISH MPS/MPN PANEL #1,17698791,CDM,302,RC,88271,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,26.77,90.1,
FISH MPS/MPN PANEL #2,17698792,CDM,302,RC,88271,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,26.77,90.1,
FISH MPS/MPN PANEL #3,17698793,CDM,302,RC,88271,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,26.77,90.1,
FISH MPS/MPN PANEL #4,17698794,CDM,302,RC,88271,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,26.77,90.1,
FISH MPS/MPN PANEL #5,17698795,CDM,302,RC,88271,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,26.77,90.1,
FISH MPS/MPN PANEL #6,17698796,CDM,302,RC,88271,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.77,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,26.77,90.1,
MOL CYTD INSITU HYB 100-300CELLS #1,17698797,CDM,302,RC,88275,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,63.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,163.2,
MOL CYTD INSITU HYB 100-300CELLS #2,17698798,CDM,302,RC,88275,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,63.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,163.2,
MOL CYTD INSITU HYB 100-300CELLS #3,17698799,CDM,302,RC,88275,HCPCS,OUTPATIENT,,,192.00,76.80,,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,60,,92.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,63.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,134.4,70,,107.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,32,,49.15,percent of total billed charges,32% of total billed charges,61.44,163.2,
EPSTEIN BARR VIRUS AB(EBNA)IGG,17698801,CDM,302,RC,86664,HCPCS,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,59.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,19.11,62.05,
EPSTEIN BARR VIRUS AB(VCA)IGG,17698802,CDM,302,RC,86665,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,22.67,73.95,
EPSTEIN BARR VIRUS AB(VCA)IGM,17698803,CDM,302,RC,86665,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,70.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,22.67,73.95,
VOLTAGE GATED CA CHANNEL,17698804,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,203.00,81.20,,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,121.8,60,,97.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,142.1,70,,113.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,23,172.55,
ANGIOTENSIN CONVERT ENZYME (CSF),17698805,CDM,301,RC,82164,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,56.36,272,,,fee schedule,272% of BCBS fee schedule,56.36,272,,,fee schedule,272% of BCBS fee schedule,56.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,18.25,59.5,
VARICELLA ZOSTER AB IGM,17698806,CDM,302,RC,86787,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,16.1,54.4,
HU ANTIBODIES(IFA)CSF,17698807,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,15.06,126.65,
YO ANTIBODIES(IFA)CSF,17698808,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,46.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,15.06,126.65,
ORGANIC ACID QUANT (URINE),17698810,CDM,301,RC,82570,HCPCS,OUTPATIENT,,,30.00,12.00,,4.79,100,,,fee schedule,100% of Aetna fee schedule,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,19.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.47,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,4.79,25.5,
OLIGOCLONAL BAND CDF,17698820,CDM,301,RC,83916,HCPCS,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,73.77,272,,,fee schedule,272% of BCBS fee schedule,73.77,272,,,fee schedule,272% of BCBS fee schedule,73.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,79.9,
BF AFP(BODY FLUID),17698822,CDM,302,RC,86316,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,76.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,76.68,
GLIPIZIDE,17699208,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,23.3,71.4,
PARATHYROID HORMONE ANTIBODY,17699209,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,170.00,68.00,,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,102,60,,81.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,119,70,,95.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,23,144.5,
CLOBAZUM (URBANYL),17699210,CDM,301,RC,80346,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,71.4,272,,,fee schedule,272% of BCBS fee schedule,71.4,272,,,fee schedule,272% of BCBS fee schedule,71.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
PANCREATIC ELASTASE,17699211,CDM,301,RC,82656,HCPCS,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,14.41,204,
BUPRENORPHINE QUANT UR,17699212,CDM,301,RC,80348,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
BUPRENORPHINE SCREEN UR,17699213,CDM,301,RC,80306,HCPCS,OUTPATIENT,,,49.00,19.60,,13.47,100,,,fee schedule,100% of Aetna fee schedule,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,53.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.42,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,13.47,53.26,
HP PNL ASPERGILIS AB,17699214,CDM,302,RC,86606,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,58.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,58.1,
HP PNL M. FAENI AB,17699215,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,49.75,
HP PNL T. VULGARIS AB,17699217,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,49.75,
HP PNL S VIRIDIS AB,17699218,CDM,302,RC,86609,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,49.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,49.75,
"MITOCHONDRIA M2 ANTIBODY (IgG), EIA",17699219,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,49.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,21.58,63.75,
ADALIMUMAB CONCENTRATION,17699220,CDM,301,RC,80145,HCPCS,OUTPATIENT,,,224.00,89.60,,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,60,,107.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,156.8,70,,125.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,48.21,190.4,
ADALIMUMAB AB,17699221,CDM,301,RC,82397,HCPCS,OUTPATIENT,,,224.00,89.60,,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,54.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,134.4,60,,107.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,156.8,70,,125.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,17.65,190.4,
THIOPURINE METABOLITES,17699222,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,52.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,23.3,80.75,
HP PNL PIDGEON SERUM AB,17699223,CDM,302,RC,86331,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,46.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.97,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,46.27,
POST VASECTOMY SEMEN ANALYSIS,17699224,CDM,301,RC,89310,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,33.21,272,,,fee schedule,272% of BCBS fee schedule,33.21,272,,,fee schedule,272% of BCBS fee schedule,33.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,33.21,
TROPONIN-I ED,17705570,CDM,301,RC,84484,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,15.58,77.35,
DIGOXIN(LANOXIN) REF LAB,17705571,CDM,300,RC,80162,HCPCS,OUTPATIENT,,,92.00,36.80,,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,51.27,272,,,fee schedule,272% of BCBS fee schedule,51.27,272,,,fee schedule,272% of BCBS fee schedule,51.27,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,55.2,60,,44.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,64.4,70,,51.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,16.6,78.2,
DEPAKENE (VALP ACID REF LAB) TOTAL,17705572,CDM,301,RC,80164,HCPCS,OUTPATIENT,,,112.49,45.00,,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,36,32,,28.8,percent of total billed charges,32% of total billed charges,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,52.31,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,67.49,60,,53.99,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.92,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,95.62,85,,76.5,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,36,32,,28.8,percent of total billed charges,32% of total billed charges,78.74,70,,62.99,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36,32,,28.8,percent of total billed charges,32% of total billed charges,36,32,,28.8,percent of total billed charges,32% of total billed charges,16.92,95.62,
FOLIC ACID (FOLATE) REF LAB,17705573,CDM,301,RC,82746,HCPCS,OUTPATIENT,,,100.00,40.00,,13.61,100,,,fee schedule,100% of Aetna fee schedule,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,56.77,272,,,fee schedule,272% of BCBS fee schedule,56.77,272,,,fee schedule,272% of BCBS fee schedule,56.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.37,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,13.61,85,
THEOPHYLLINE (REF LAB),17705574,CDM,301,RC,80198,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,54.64,272,,,fee schedule,272% of BCBS fee schedule,54.64,272,,,fee schedule,272% of BCBS fee schedule,54.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,17.67,74.8,
DILANTIN (PHENYTOIN) REF LAB,17705575,CDM,301,RC,80185,HCPCS,OUTPATIENT,,,94.00,37.60,,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,51.19,272,,,fee schedule,272% of BCBS fee schedule,51.19,272,,,fee schedule,272% of BCBS fee schedule,51.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,56.4,60,,45.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,65.8,70,,52.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,30.08,32,,24.06,percent of total billed charges,32% of total billed charges,16.56,79.9,
ColoVantage(methylated septin 9),17785233,CDM,310,RC,81327,HCPCS,OUTPATIENT,,,810.00,324.00,,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486,60,,388.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,688.5,85,,550.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,567,70,,453.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,259.2,32,,207.36,percent of total billed charges,32% of total billed charges,240,688.5,
RA (BODY FLUIDS),17909105,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,21.92,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.67,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,7.67,22.1,
"FENTANYL (Pain Management, Quant)",17909106,CDM,301,RC,83925,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
ASSESSMENT PROTOCOL,18000001,CDM,412,RC,94640,HCPCS,OUTPATIENT,,,418.00,167.20,,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.8,60,,200.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,13.61,355.3,
****AMB O2,18000002,CDM,279,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
"SMOKING CESSATION, INTERMED 3-10 MIN",18000003,CDM,940,RC,99406,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,19.34,62.9,
****AMB AEROSOL 02,18000004,CDM,279,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
"SMOKING CESSATION, INTENSE >10 MIN",18000005,CDM,940,RC,99407,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
NELLCOR OXISENSOR INFANT,18000009,CDM,272,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
NELLCOR OXISENSOR NEO,18000010,CDM,272,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
PULSE OX OVERNITE,18000011,CDM,460,RC,94762,HCPCS,OUTPATIENT,,,477.00,190.80,,,,,,other ,not seperately reimbursable,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,254.51,272,,,fee schedule,272% of BCBS fee schedule,254.51,272,,,fee schedule,272% of BCBS fee schedule,254.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,286.2,60,,228.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,333.9,70,,267.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,152.64,32,,122.11,percent of total billed charges,32% of total billed charges,31.89,405.45,
NELLCOR OXISENSOR PEDIATRIC,18000012,CDM,272,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
OXYSOFTN SENSOR,18000013,CDM,272,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
"GASES,BLOOD PH, PCO2,PO2,CO2,HCO3",18000016,CDM,301,RC,82805,HCPCS,OUTPATIENT,,,129.00,51.60,,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,109.53,272,,,fee schedule,272% of BCBS fee schedule,109.53,272,,,fee schedule,272% of BCBS fee schedule,109.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,77.4,60,,61.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,98.46,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,90.3,70,,72.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,41.28,32,,33.02,percent of total billed charges,32% of total billed charges,41.28,109.65,
CARBOXYHEMAGLOBIN,18000017,CDM,301,RC,82375,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,47.6,272,,,fee schedule,272% of BCBS fee schedule,47.6,272,,,fee schedule,272% of BCBS fee schedule,47.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,15.4,73.1,
ABG PRO-VENT MICRO,18000018,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DRAINAGE TRAP,18000019,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DRAINAGE KIT,18000020,CDM,272,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
ANCHOR FAST TUBE HOLDER,18000021,CDM,272,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
****ARTERIAL BLOOD GAS,18000032,CDM,305,RC,82800,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,13.14,272,,,fee schedule,272% of BCBS fee schedule,13.14,272,,,fee schedule,272% of BCBS fee schedule,13.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
BIPAP O2 CONNECTORS,18000033,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PULMONARY RESUS,18000040,CDM,410,RC,92590,HCPCS,OUTPATIENT,,,521.00,208.40,,,,,,other ,not seperately reimbursable,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312.6,60,,250.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,442.85,85,,354.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,364.7,70,,291.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,166.72,32,,133.38,percent of total billed charges,32% of total billed charges,166.72,442.85,
MOUTHPIECE/PULMONARY FILTER,18000045,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ACAPELLA BLUE,18000082,CDM,272,RC,,,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
MASK AEROSAL PEDI,18000101,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MASK ADULT AEROSAL,18000102,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CO2 CANNULA MASIMO,18000103,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
MASK OXY PEDI,18000104,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CORR TUBING 3 SECTIONS,18000107,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NOSE CLIP,18000108,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PULSE OX EXERCISE,18000109,CDM,410,RC,94761,HCPCS,OUTPATIENT,,,255.00,102.00,,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,151.1,272,,,fee schedule,272% of BCBS fee schedule,151.1,272,,,fee schedule,272% of BCBS fee schedule,151.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,153,60,,122.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,178.5,70,,142.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,4.28,216.75,
CPAP INITIATION AND MGMT,18000110,CDM,410,RC,94660,HCPCS,OUTPATIENT,,,348.00,139.20,,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.8,60,,167.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,295.8,85,,236.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,243.6,70,,194.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,79.86,295.8,
MDI TREATMENT,18000115,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,13.61,105.4,
HJB JHBG BV VBG,18000119,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HI HUMID AEROSOL 02 PER HR,18000131,CDM,272,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
HIGH HUMIDITY 02 SET UP,18000149,CDM,271,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
AEROSOL TX INITIAL,18000164,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,408.00,163.20,,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,60,,195.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,285.6,70,,228.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,13.61,346.8,
CONT. NEBULIZER SET UP,18000166,CDM,412,RC,94664,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
INHALATION TREAMENT INITIAL,18000202,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,418.00,167.20,,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.8,60,,200.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,13.61,355.3,
MDI Tx PRN SUBSEQUENT,18000203,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,418.00,167.20,,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.8,60,,200.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,13.61,355.3,
MDI INITIAL ASSESMENT,18000204,CDM,410,RC,94664,HCPCS,OUTPATIENT,,,418.00,167.20,,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.8,60,,200.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,20.51,355.3,
MDI SUBSEQUENT #3,18000205,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,418.00,167.20,,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.8,60,,200.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,292.6,70,,234.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,133.76,32,,107.01,percent of total billed charges,32% of total billed charges,13.61,355.3,
SWIVEL ELBOW FOR TRACHS & ET TUBES,18000230,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ADVAIR(MDI 2PUFFS 45/21),18000250,CDM,250,RC,J7620,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
ADVAIR(MDI 2PUFFS 115/21),18000251,CDM,250,RC,J7620,HCPCS,OUTPATIENT,,,10228.00,4091.20,,,,,,other ,not seperately reimbursable,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6136.8,60,,4909.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,8693.8,85,,6955.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,7159.6,70,,5727.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,3272.96,32,,2618.37,percent of total billed charges,32% of total billed charges,3272.96,8693.8,
ADVAIR(MDI 2PUFFS 230/21),18000252,CDM,250,RC,J7620,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SYMBICORT 160/4.5,18000255,CDM,250,RC,,,OUTPATIENT,,,229.00,91.60,,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.4,60,,109.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,160.3,70,,128.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,32,,58.62,percent of total billed charges,32% of total billed charges,73.28,194.65,
SYMBICORT 80/4.5,18000256,CDM,250,RC,,,OUTPATIENT,,,201.00,80.40,,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.6,60,,96.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,140.7,70,,112.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,32,,51.46,percent of total billed charges,32% of total billed charges,64.32,170.85,
ACAPELLA GREEN,18000275,CDM,272,RC,,,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
AMBU BAG ADULT,18000297,CDM,271,RC,,,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
VENTILATOR CIRCUIT,18000305,CDM,272,RC,,,OUTPATIENT,,,7.50,3.00,,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.5,60,,3.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,6.38,85,,5.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,5.25,70,,4.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,6.38,
V60 CIRCUIT,18000306,CDM,272,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
VENTILATOR INITIAL SET UP,18000321,CDM,410,RC,94002,HCPCS,OUTPATIENT,,,514.00,205.60,,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.4,60,,246.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,118.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,436.9,85,,349.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,359.8,70,,287.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,118.56,436.9,
***POLYSMONOGRAPHY W/CAP TITRATE,18000350,CDM,740,RC,95811,HCPCS,OUTPATIENT,,,2922.00,1168.80,,469.38,80,,,fee schedule,80% of Aetna fee schedule,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1753.2,60,,1402.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,617.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2483.7,85,,1986.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2045.4,70,,1636.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,469.38,2483.7,
O2 HUMIDIFIER 340ML,18000362,CDM,272,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
NASAL CANNULA INFANT,18000388,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
NASAL CANNULA PEDI,18000390,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
MASK OXYGEN INFANT,18000391,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
TERBUTALINE,18000392,CDM,251,RC,J7611,HCPCS,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
O2 PER 12 HRS,18000420,CDM,272,RC,,,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,102,
O2 (ER ONLY),18000421,CDM,272,RC,,,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,102,
OXY TIP BLUE ADULT,18000439,CDM,272,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
OXY TIP PURPLE PEDS,18000440,CDM,272,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
O2 SUPPLY TUBING,18000446,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MOUTH PIECE-DISP,18000460,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PFT COMPLETE,18000461,CDM,460,RC,94010,HCPCS,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,22.55,127.5,
LUNG VOLUME,18000462,CDM,460,RC,94727,HCPCS,OUTPATIENT,,,306.00,122.40,,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,63.02,272,,,fee schedule,272% of BCBS fee schedule,63.02,272,,,fee schedule,272% of BCBS fee schedule,63.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,183.6,60,,146.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,214.2,70,,171.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,38.39,260.1,
DLCO,18000463,CDM,460,RC,94729,HCPCS,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,161.21,272,,,fee schedule,272% of BCBS fee schedule,161.21,272,,,fee schedule,272% of BCBS fee schedule,161.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,59.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,59.91,255,
****F/V LOOP RESP FLO VOL LOOP,18000464,CDM,460,RC,94375,HCPCS,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,43.9,272,,,fee schedule,272% of BCBS fee schedule,43.9,272,,,fee schedule,272% of BCBS fee schedule,43.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,29.05,157.25,
VENT CIRCUIT INFANT PORTABLE,18000467,CDM,272,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
VENT CIRCUIT ADULT/CHILD PORTABLE,18000468,CDM,272,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
PFT COMPLETE PRE-POST BRONCHODILATOR,18000503,CDM,460,RC,94060,HCPCS,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,85.16,272,,,fee schedule,272% of BCBS fee schedule,85.16,272,,,fee schedule,272% of BCBS fee schedule,85.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,34.74,233.75,
HUMIDIFIER ROOM SETUP,18000545,CDM,272,RC,,,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
TRACH SUCTION(NTS),18000552,CDM,412,RC,31720,HCPCS,OUTPATIENT,,,425.00,170.00,,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,255,60,,204,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,75.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,297.5,70,,238,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,136,32,,108.8,percent of total billed charges,32% of total billed charges,136,32,,108.8,percent of total billed charges,32% of total billed charges,75.61,361.25,
SPUTUM INDUCTION VIA NEB,18000560,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,13.61,105.4,
MASK VENTED CPAP,18000603,CDM,272,RC,,,OUTPATIENT,,,159.00,63.60,,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.4,60,,76.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,111.3,70,,89.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,135.15,
MASK MED VENTED CPAP,18000604,CDM,272,RC,,,OUTPATIENT,,,310.00,124.00,,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186,60,,148.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,263.5,85,,210.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,217,70,,173.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,263.5,
MASK SM VENTED,18000605,CDM,272,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
MASK NONVENTED LRG,18000606,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
MASK NONVENTED MEDIUM,18000607,CDM,272,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
MASK NONVENTED SMALL,18000608,CDM,272,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
****TRANSFER CHARGE PER HR R.T.,18000644,CDM,410,RC,94799,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
MANIPULATION CHEST WALL INITIAL,18000669,CDM,410,RC,94667,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
INCENTIVE SPIROMETER,18000685,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CANNULA ADULT HI FLOW,18000686,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
HUMIDIFIER HI FLOW,18000687,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
INCENT SPIRO SETUP,18000694,CDM,272,RC,,,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,141.95,
ARTERIAL STICK,18000701,CDM,300,RC,36600,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,36.23,200.6,
MANIPULATION CHEST WALL SUBSEQUENT,18000770,CDM,410,RC,94668,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
CONT INHAL TX 1ST HR,18000771,CDM,410,RC,94644,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,74.14,200.6,
CONT INHAL TX EA ADDNL HR,18000772,CDM,410,RC,94645,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,19.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,19.3,63.75,
PULMONARY STRESS TEST 6 MIN WALK,18000773,CDM,460,RC,94618,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,130.37,272,,,fee schedule,272% of BCBS fee schedule,130.37,272,,,fee schedule,272% of BCBS fee schedule,130.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,13.61,200.6,
EXPIRED GAS COLLECTION,18000774,CDM,460,RC,94250,HCPCS,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,12.59,272,,,fee schedule,272% of BCBS fee schedule,12.59,272,,,fee schedule,272% of BCBS fee schedule,12.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,12.59,105.4,
BRONCHIAL LAVAGE,18000775,CDM,460,RC,31624,HCPCS,OUTPATIENT,,,3039.00,1215.60,,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1823.4,60,,1458.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,323.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,2583.15,85,,2066.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,2127.3,70,,1701.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,972.48,32,,777.98,percent of total billed charges,32% of total billed charges,323.83,2583.15,
PEP THERAPY (ACAPELLA),18000776,CDM,410,RC,94664,HCPCS,OUTPATIENT,,,408.00,163.20,,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,60,,195.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,285.6,70,,228.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,20.51,346.8,
****ARTERIAL STICK IN LAB/TRTMT RM,18000777,CDM,761,RC,36600,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
VIBRATION SUBS/FLUTTER VALVE,18001014,CDM,410,RC,94667,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,27.64,200.6,
****TECHNICIAN STAND BY PER 15 MIN,18001055,CDM,410,RC,94799,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
VENTILATOR SUBSEQUENT DAY,18001063,CDM,410,RC,94003,HCPCS,OUTPATIENT,,,446.00,178.40,,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,83.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,83.15,379.1,
****ZO NOT USEMECH VENT ER DAILY,18001065,CDM,410,RC,,,OUTPATIENT,,,374.00,149.60,,,,,,other ,not seperately reimbursable,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.4,60,,179.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,317.9,85,,254.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,261.8,70,,209.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,119.68,32,,95.74,percent of total billed charges,32% of total billed charges,119.68,317.9,
PULSE OXIMETER PERIODIC READIN,18001111,CDM,460,RC,94760,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,3.05,57.96,
PULSE OXIMETER CONTINUOUS,18001113,CDM,460,RC,94762,HCPCS,OUTPATIENT,,,302.00,120.80,,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,254.51,272,,,fee schedule,272% of BCBS fee schedule,254.51,272,,,fee schedule,272% of BCBS fee schedule,254.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,181.2,60,,144.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,211.4,70,,169.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,31.89,256.7,
FILTER RT020,18001114,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
HIGH HUMIDITY 1000 ML.,18001120,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PULSE OXIMETER PERIODIC READIN,18001121,CDM,460,RC,94760,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,3.05,57.96,
EASY CAP ADULT,18001132,CDM,272,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
EASY CAP PEDI,18001133,CDM,272,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
INTUBATION,18001139,CDM,410,RC,31500,HCPCS,OUTPATIENT,,,458.00,183.20,,,,,,other ,not seperately reimbursable,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.8,60,,219.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,185.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,320.6,70,,256.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,146.56,32,,117.25,percent of total billed charges,32% of total billed charges,146.56,389.3,
STERILE WATER 500ML,18001140,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
EXTUBATION,18001147,CDM,410,RC,94799,HCPCS,OUTPATIENT,,,144.00,57.60,,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,60,,69.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,100.8,70,,80.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,32,,36.86,percent of total billed charges,32% of total billed charges,46.08,122.4,
BIPAP EACH ADDL DAY,18001154,CDM,410,RC,94660,HCPCS,OUTPATIENT,,,457.00,182.80,,,,,,other ,not seperately reimbursable,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.2,60,,219.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,388.45,85,,310.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,319.9,70,,255.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,146.24,32,,116.99,percent of total billed charges,32% of total billed charges,79.86,388.45,
CPAP INITIATION AND MANAGEMENT,18001155,CDM,410,RC,94660,HCPCS,OUTPATIENT,,,514.00,205.60,,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.4,60,,246.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,436.9,85,,349.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,359.8,70,,287.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,164.48,32,,131.58,percent of total billed charges,32% of total billed charges,79.86,436.9,
BIPAP CIRCUIT,18001156,CDM,272,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
PFT SINGLE BREATH,18001170,CDM,460,RC,94150,HCPCS,OUTPATIENT,,,306.00,122.40,,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.6,60,,146.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,214.2,70,,171.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,25.39,260.1,
MASK ADULT OXY,18001189,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MASK ADULT TRACH,18001190,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
OXYMASK BY MEDLINE,18001191,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
HIGH VOLUME NEBULIZE,18001204,CDM,272,RC,,,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
MASK MULTI VENT,18001220,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
A-LINE INSERTION,18001238,CDM,940,RC,36620,HCPCS,OUTPATIENT,,,178.00,71.20,,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.8,60,,85.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,56.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,151.3,85,,121.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,124.6,70,,99.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,32,,45.57,percent of total billed charges,32% of total billed charges,56.96,151.3,
PEEP VALVE,18001240,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
MOUTHPIECE AEROGEN,18001255,CDM,272,RC,,,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
ENDOTRACH TUBE HOLDER ADULT,18001283,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
ENDOTRACH TUBE HOLDER PEDI,18001284,CDM,272,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
BALLARD CATH Sx,18001290,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
CONCHA H2O-VENT 1650ML,18001300,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SPIRIVA 18 MCG CAPSULES W/ HANDIHALER,18002000,CDM,251,RC,,,OUTPATIENT,,,103.00,41.20,,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.8,60,,49.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,72.1,70,,57.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,87.55,
ALBUTEROL 2.5 MG/3 ML NEBULIZER SOLUTION,18002001,CDM,251,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
IPRATROPIUM 0.5 MG/2.5 ML NEBULIZER SOLN,18002002,CDM,251,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
NSS (SODIUM CHLORIDE) 0.9% 3ML,18002003,CDM,272,RC,A4290,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
RACEPINEPHRINE 0.5 ML - NEBULIZER SOLN,18002004,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
XOPENEX 0.63 MG/3 ML NEBULIZER SOLN,18002005,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
ACETYLCYSTEINE (MUCOMYST) 20% 30ML,18002006,CDM,251,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
INTAL (CROMOLYN SODIUM 20MG/2ML),18002007,CDM,251,RC,J7631,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
IPRAT/ALBUT 0.5-3 MG/3 ML NEBULIZER SOLN,18002008,CDM,251,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
ALUPENT 0.6%,18002009,CDM,250,RC,J7669,HCPCS,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
ALUPENT 0.4%,18002010,CDM,250,RC,J7669,HCPCS,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
ACCUNEB 1.25MG,18002011,CDM,250,RC,J7613,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PULMICORT 0.25 MG/2 ML NEBULIZER SOLN,18002012,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
ACCUNEB 0.63MG,18002013,CDM,250,RC,J7613,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
AMBU BAG INFANT,18002014,CDM,272,RC,,,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
ALBUTEROL 1.25 MG/3 ML NEBULIZER SOLN,18002015,CDM,251,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
OPTI CHAMBER,18002016,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
ALBUTEROL INHALER,18002017,CDM,251,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
COMBIVENT(MDI 2PUFFS),18002018,CDM,251,RC,,,OUTPATIENT,,,7.95,3.18,,,,,,other ,not seperately reimbursable,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.77,60,,3.82,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,6.76,85,,5.41,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,5.57,70,,4.46,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,2.54,32,,2.03,percent of total billed charges,32% of total billed charges,2.54,6.76,
FLOVENT 110(MDI 2PUFFS),18002019,CDM,251,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
FLOVENT 220(MDI 2PUFFS),18002020,CDM,251,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
FLOVENT 44 MCG (MDI 2PUFFS),18002021,CDM,251,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ATROVENT HFA - PER 2 PUFFS,18002022,CDM,251,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
XOPENEX(MDI 2PUFFS),18002026,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
*******,18002028,CDM,251,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SODIUM CHLORIDE 3% NEB 4ML,18002029,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
AMINOPHYLLINE 500 MG/20 ML SDV - RT USE,18002030,CDM,250,RC,J0280,HCPCS,OUTPATIENT,,,13.68,5.47,,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.21,60,,6.57,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,11.63,85,,9.3,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,9.58,70,,7.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,11.63,
PULMICORT 0.5 MG/2 ML NEBULIZER SOLN,18002035,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
EKG TRACING FOR IPPE,18002036,CDM,730,RC,G0404,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,7.53,43.35,
COMBIVENT RESPIMAT,18002038,CDM,250,RC,,,OUTPATIENT,,,465.00,186.00,,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,279,60,,223.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,325.5,70,,260.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,32,,119.04,percent of total billed charges,32% of total billed charges,148.8,395.25,
FLUTTER VALVE,18002131,CDM,272,RC,,,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,141.95,
VIBRATION INITIAL/FLUTTER VALV,18002132,CDM,410,RC,94667,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,27.64,200.6,
VENT HUMIDIFIER BAG,18003001,CDM,272,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
**POLYSMONOGRAPHY W/EEG,18003500,CDM,740,RC,95810,HCPCS,OUTPATIENT,,,2710.00,1084.00,,447.25,80,,,fee schedule,80% of Aetna fee schedule,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1626,60,,1300.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,590.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,1897,70,,1517.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,447.25,2303.5,
**POLYSMONOGRAPHY W/CAP TITRATE,18003501,CDM,740,RC,95811,HCPCS,OUTPATIENT,,,2922.00,1168.80,,469.38,80,,,fee schedule,80% of Aetna fee schedule,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1753.2,60,,1402.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,617.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2483.7,85,,1986.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2045.4,70,,1636.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,469.38,2483.7,
***RT TREATMENT ROOM,18003502,CDM,761,RC,,,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
SUCTION -INTRATHORACIC,18031760,CDM,412,RC,31720,HCPCS,OUTPATIENT,,,7200.00,2880.00,,,,,,other ,not seperately reimbursable,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,4320,60,,3456,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,75.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,6120,85,,4896,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,5040,70,,4032,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,2304,32,,1843.2,percent of total billed charges,32% of total billed charges,75.61,6120,
DOBUTAMINE IV:500MG/250ML,18041036,CDM,258,RC,J1250,HCPCS,OUTPATIENT,,,209.00,83.60,,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.4,60,,100.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,146.3,70,,117.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,32,,53.5,percent of total billed charges,32% of total billed charges,66.88,177.65,
METH HEMOGLOBIN,18083050,CDM,301,RC,83050,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,15.78,272,,,fee schedule,272% of BCBS fee schedule,15.78,272,,,fee schedule,272% of BCBS fee schedule,15.78,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
PEAK FLOW PRE-POST BRONCHODILATOR,18094060,CDM,410,RC,94060,HCPCS,OUTPATIENT,,,306.00,122.40,,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,85.16,272,,,fee schedule,272% of BCBS fee schedule,85.16,272,,,fee schedule,272% of BCBS fee schedule,85.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,183.6,60,,146.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,214.2,70,,171.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,97.92,32,,78.34,percent of total billed charges,32% of total billed charges,34.74,260.1,
PEAK FLOW METER (STERILE SUPPLY),18094065,CDM,272,RC,,,OUTPATIENT,,,31.00,12.40,,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.6,60,,14.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,26.35,
****MAXIMAL VOLUNTARY VENTILATION,18094200,CDM,460,RC,94200,HCPCS,OUTPATIENT,,,116.00,46.40,,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,23.47,272,,,fee schedule,272% of BCBS fee schedule,23.47,272,,,fee schedule,272% of BCBS fee schedule,23.47,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,69.6,60,,55.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,81.2,70,,64.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,37.12,32,,29.7,percent of total billed charges,32% of total billed charges,14.83,98.6,
SIMPLE 6 MIN WALK,18094620,CDM,460,RC,94620,HCPCS,OUTPATIENT,,,307.00,122.80,,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.2,60,,147.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,214.9,70,,171.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,260.95,
STRESS ELECTROBE RADIO,19000013,CDM,271,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
EKG TRACING ONLY,19000014,CDM,730,RC,93005,HCPCS,OUTPATIENT,,,154.00,61.60,,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,92.4,60,,73.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,107.8,70,,86.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,7.53,130.9,
*****EKG W/IGXT,19000016,CDM,730,RC,93015,HCPCS,OUTPATIENT,,,427.00,170.80,,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256.2,60,,204.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,298.9,70,,239.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,87.94,362.95,
****RHYTHM STRIP (PER DAY),19000022,CDM,730,RC,93040,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,15.85,42.5,
EKG DAY SURGERY,19000024,CDM,730,RC,93005,HCPCS,OUTPATIENT,,,154.00,61.60,,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,98.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,92.4,60,,73.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,107.8,70,,86.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,49.28,32,,39.42,percent of total billed charges,32% of total billed charges,7.53,130.9,
ECG 48 HR RECORDING/HOOKUP/DISCONNECT,19000032,CDM,731,RC,93225,HCPCS,OUTPATIENT,,,321.00,128.40,,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,272.14,272,,,fee schedule,272% of BCBS fee schedule,272.14,272,,,fee schedule,272% of BCBS fee schedule,272.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,192.6,60,,154.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,224.7,70,,179.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,102.72,32,,82.18,percent of total billed charges,32% of total billed charges,23.36,272.85,
**ECG 24 HR MICROPROCESSOR ANAYLSIS/REPO,19000033,CDM,731,RC,93226,HCPCS,OUTPATIENT,,,562.00,224.80,,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,480.08,272,,,fee schedule,272% of BCBS fee schedule,480.08,272,,,fee schedule,272% of BCBS fee schedule,480.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,337.2,60,,269.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,45.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,477.7,85,,382.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,393.4,70,,314.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,45.7,480.08,
ECG 30 DAY EVENT 24 HR RECORDING,19000035,CDM,731,RC,93270,HCPCS,OUTPATIENT,,,147.00,58.80,,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,60,,70.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,102.9,70,,82.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,10.36,124.95,
EXTRNL RECORD UPTO 48 HR SCAN ANALYSIS,19000036,CDM,731,RC,93226,HCPCS,OUTPATIENT,,,236.00,94.40,,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,480.08,272,,,fee schedule,272% of BCBS fee schedule,480.08,272,,,fee schedule,272% of BCBS fee schedule,480.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,141.6,60,,113.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,45.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,165.2,70,,132.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,75.52,32,,60.42,percent of total billed charges,32% of total billed charges,45.7,480.08,
****EKG GLOBAL,19000114,CDM,730,RC,93000,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,17.94,85,
ADENOSCAN INJ 6MG PER DOSE,19000150,CDM,636,RC,J0153,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
ADENOSCAN INJ 30MG PER DOSE,19000152,CDM,636,RC,J0153,HCPCS,OUTPATIENT,,,224.00,89.60,,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,60,,107.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,156.8,70,,125.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,190.4,
LEXISCAN 0.08MG/ML 5ML PF,19000154,CDM,636,RC,J2785,HCPCS,OUTPATIENT,,,554.00,221.60,,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.4,60,,265.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,470.9,85,,376.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,387.8,70,,310.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,32,,141.82,percent of total billed charges,32% of total billed charges,177.28,470.9,
CARDIAC STRESS TEST,19001305,CDM,482,RC,93017,HCPCS,OUTPATIENT,,,562.00,224.80,,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,368.37,272,,,fee schedule,272% of BCBS fee schedule,368.37,272,,,fee schedule,272% of BCBS fee schedule,368.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,337.2,60,,269.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,477.7,85,,382.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,393.4,70,,314.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,42.66,477.7,
0,19090315,CDM,133,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
****ECG DISABILITY DETERMINATION,19093000,CDM,731,RC,93000,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,17.94,71.4,
STRESS TEST W/INTERPRETATION,19093015,CDM,482,RC,93015,HCPCS,OUTPATIENT,,,225.00,90.00,,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135,60,,108,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,157.5,70,,126,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,191.25,
****STRESS TEST GLOBIAL,19093016,CDM,482,RC,93016,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,27.2,96.9,
****PHYSICIAN DISABILITY DETERMINATION,19099201,CDM,731,RC,99201,HCPCS,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
****ELECTROENCEPHALOGRAM,20000001,CDM,740,RC,95816,HCPCS,OUTPATIENT,,,504.00,201.60,,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,122.54,272,,,fee schedule,272% of BCBS fee schedule,122.54,272,,,fee schedule,272% of BCBS fee schedule,122.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,302.4,60,,241.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,394.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,428.4,85,,342.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,352.8,70,,282.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,122.54,428.4,
****EEG AWAKE & DROWSY,20000002,CDM,740,RC,95816,HCPCS,OUTPATIENT,,,504.00,201.60,,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,122.54,272,,,fee schedule,272% of BCBS fee schedule,122.54,272,,,fee schedule,272% of BCBS fee schedule,122.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,302.4,60,,241.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,394.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,428.4,85,,342.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,352.8,70,,282.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,122.54,428.4,
****EEG FOR ADULT,20000003,CDM,740,RC,95816,HCPCS,OUTPATIENT,,,504.00,201.60,,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,122.54,272,,,fee schedule,272% of BCBS fee schedule,122.54,272,,,fee schedule,272% of BCBS fee schedule,122.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,302.4,60,,241.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,394.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,428.4,85,,342.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,352.8,70,,282.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,161.28,32,,129.02,percent of total billed charges,32% of total billed charges,122.54,428.4,
MASK MEDIUM CPAP,21000607,CDM,272,RC,,,OUTPATIENT,,,440.00,176.00,,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,60,,211.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,308,70,,246.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,374,
MASK SMALL CPAP,21000608,CDM,272,RC,,,OUTPATIENT,,,440.00,176.00,,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,60,,211.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,308,70,,246.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,374,
POLYSMONO 6YO 4 OR > PARAMS,21003500,CDM,920,RC,95810,HCPCS,OUTPATIENT,,,2710.00,1084.00,,447.25,80,,,fee schedule,80% of Aetna fee schedule,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1626,60,,1300.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,590.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,1897,70,,1517.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,447.25,2303.5,
POLYSMONOGRAPHY W/CAP TITRATE,21003501,CDM,920,RC,95811,HCPCS,OUTPATIENT,,,2922.00,1168.80,,469.38,80,,,fee schedule,80% of Aetna fee schedule,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1753.2,60,,1402.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,617.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2483.7,85,,1986.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2045.4,70,,1636.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,469.38,2483.7,
SLEEP STUDY UNATTENDED BY TECH,21003502,CDM,920,RC,95806,HCPCS,OUTPATIENT,,,501.00,200.40,,126.17,80,,,fee schedule,80% of Aetna fee schedule,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.6,60,,240.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,57.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,350.7,70,,280.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,57.29,425.85,
POLYSOMNOGRAPHY LTD 6+ Y/O ATTENDED,21003503,CDM,920,RC,95810,HCPCS,OUTPATIENT,,,1800.00,720.00,,447.25,80,,,fee schedule,80% of Aetna fee schedule,576,32,,460.8,percent of total billed charges,32% of total billed charges,576,32,,460.8,percent of total billed charges,32% of total billed charges,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1080,60,,864,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,590.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,576,32,,460.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,32,,460.8,percent of total billed charges,32% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,32,,460.8,percent of total billed charges,32% of total billed charges,576,32,,460.8,percent of total billed charges,32% of total billed charges,1260,70,,1008,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,576,32,,460.8,percent of total billed charges,32% of total billed charges,576,32,,460.8,percent of total billed charges,32% of total billed charges,447.25,1530,
POLYSOMNOGRAPHY LTD 6+ YR W/CPAP ATNDED,21003504,CDM,920,RC,95810,HCPCS,OUTPATIENT,,,2922.00,1168.80,,447.25,80,,,fee schedule,80% of Aetna fee schedule,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1753.2,60,,1402.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,590.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2483.7,85,,1986.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2045.4,70,,1636.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,447.25,2483.7,
POLYSMONOGRAPHY W/EEG LMTD,21003505,CDM,920,RC,95810,HCPCS,OUTPATIENT,,,2710.00,1084.00,,447.25,80,,,fee schedule,80% of Aetna fee schedule,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,610.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1626,60,,1300.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,590.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,1897,70,,1517.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,867.2,32,,693.76,percent of total billed charges,32% of total billed charges,447.25,2303.5,
POLYSMONO 6YO W/4 PARAMS CPAP,21003506,CDM,920,RC,95811,HCPCS,OUTPATIENT,,,2922.00,1168.80,,469.38,80,,,fee schedule,80% of Aetna fee schedule,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,1496,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1753.2,60,,1402.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,617.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2483.7,85,,1986.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2045.4,70,,1636.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,469.38,2483.7,
INTRA-CATH SUPPLIES,22005678,CDM,251,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
US BREAST BIOPSY PERC LOC 1ST LESION,22019103,CDM,360,RC,19083,HCPCS,OUTPATIENT,,,3027.00,1210.80,,3000,100,,,case rate,pays based on per visit rate,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1816.2,60,,1452.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,645.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,2572.95,85,,2058.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,968.64,32,,774.91,percent of total billed charges,32% of total billed charges,645.85,3000,
MM LOCALIZATION CLIP PLACEMENT,22019295,CDM,360,RC,19283,HCPCS,OUTPATIENT,,,266.00,106.40,,3000,100,,,case rate,pays based on per visit rate,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,327.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,3000,
KNEE BILAT STANDING 6V,22065663,CDM,320,RC,73565,HCPCS,OUTPATIENT,,,167.00,66.80,,27.36,80,,,fee schedule,80% of Aetna fee schedule,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,27.36,141.95,
TMJ'S BIILAT OPEN & CLOSED MOUTH,22070330,CDM,320,RC,70330,HCPCS,OUTPATIENT,,,348.00,139.20,,35.89,80,,,fee schedule,80% of Aetna fee schedule,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,76.05,272,,,fee schedule,272% of BCBS fee schedule,76.05,272,,,fee schedule,272% of BCBS fee schedule,76.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,208.8,60,,167.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,51.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,295.8,85,,236.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,243.6,70,,194.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,35.89,295.8,
CHEST 2V + APICAL LORDOTIC,22071021,CDM,324,RC,71047,HCPCS,OUTPATIENT,,,213.00,85.20,,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,49.86,272,,,fee schedule,272% of BCBS fee schedule,49.86,272,,,fee schedule,272% of BCBS fee schedule,49.86,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,127.8,60,,102.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,149.1,70,,119.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,35.95,181.05,
OMNIPAQUE 240 - 50 ML BOTTLE,22071022,CDM,255,RC,Q9966,HCPCS,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
OMNIPAQUE 240 - 100 ML BOTTLE,22071023,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
OMNIPAQUE 300 - 50 ML BOTTLE,22071024,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
OMNIPAQUE 300 - 100 ML BOTTLE,22071025,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
OMNIPAQUE 350 - 50 ML BOTTLE,22071026,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
OMNIPAQUE 350 - 100 ML BOTTLE,22071027,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
PROVAYBLUE (METHYLENE BLUE) 1MG,22071028,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,32.20,12.88,,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.32,60,,15.46,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,27.37,85,,21.9,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,22.54,70,,18.03,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,27.37,
CHEST 4V,22071030,CDM,324,RC,71048,HCPCS,OUTPATIENT,,,415.00,166.00,,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,51.46,272,,,fee schedule,272% of BCBS fee schedule,51.46,272,,,fee schedule,272% of BCBS fee schedule,51.46,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,249,60,,199.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,290.5,70,,232.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,38.39,352.75,
CHEST W/FLUOROSCOPY,22071034,CDM,324,RC,71048,HCPCS,OUTPATIENT,,,257.00,102.80,,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,51.46,272,,,fee schedule,272% of BCBS fee schedule,51.46,272,,,fee schedule,272% of BCBS fee schedule,51.46,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,154.2,60,,123.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,218.45,85,,174.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,179.9,70,,143.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,82.24,32,,65.79,percent of total billed charges,32% of total billed charges,38.39,218.45,
BRONCHOGRAM UNIL RT RS&I,22071040,CDM,324,RC,76499,HCPCS,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
BRONCHOGRAM BILAT  RS&I,22071060,CDM,324,RC,76499,HCPCS,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
RIBS LT 2 VIEWS,22071100,CDM,320,RC,71100,HCPCS,OUTPATIENT,,,160.00,64.00,,24.11,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,24.11,136,
RIBS RT 2 VIEWS,22071101,CDM,320,RC,71100,HCPCS,OUTPATIENT,,,160.00,64.00,,24.11,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,24.11,136,
HIP ARTHOGRAM LT RS & I,22071525,CDM,322,RC,73525,HCPCS,OUTPATIENT,,,984.00,393.60,,77.11,80,,,fee schedule,80% of Aetna fee schedule,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,590.4,60,,472.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,836.4,85,,669.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,688.8,70,,551.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,77.11,836.4,
KNEE ARTHROGRAM  LT PROCEDURE RS&I,22071580,CDM,322,RC,73580,HCPCS,OUTPATIENT,,,596.00,238.40,,104.3,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,147.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,104.3,506.6,
SPINE CROSS TABLE LAT TO CLEAR,22072020,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,101.00,40.40,,17.62,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,17.62,85.85,
SPINE THORACOLUMBAR 2 V,22072080,CDM,320,RC,72080,HCPCS,OUTPATIENT,,,177.00,70.80,,27.95,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,27.95,150.45,
SCOLIOSIS AP/LAT 4-5V,22072090,CDM,320,RC,72083,HCPCS,OUTPATIENT,,,555.00,222.00,,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,66.8,272,,,fee schedule,272% of BCBS fee schedule,66.8,272,,,fee schedule,272% of BCBS fee schedule,66.8,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,66.8,471.75,
SPINE LUMBAR COMP W/FLEX  & EXT 7V,22072114,CDM,320,RC,72114,HCPCS,OUTPATIENT,,,220.00,88.00,,56.9,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,107.33,272,,,fee schedule,272% of BCBS fee schedule,107.33,272,,,fee schedule,272% of BCBS fee schedule,107.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,57.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,56.9,187,
L SPINE Bending only 4Views,22072120,CDM,320,RC,72120,HCPCS,OUTPATIENT,,,132.00,52.80,,40.21,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,36.76,112.2,
MYELOGRAM L SPINE,22072265,CDM,329,RC,72265,HCPCS,OUTPATIENT,,,1050.00,420.00,,94.7,80,,,fee schedule,80% of Aetna fee schedule,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,369.81,272,,,fee schedule,272% of BCBS fee schedule,369.81,272,,,fee schedule,272% of BCBS fee schedule,369.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,630,60,,504,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,85.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,892.5,85,,714,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,735,70,,588,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,85.91,892.5,
MYELOGRAM 2 OR MORE REGIONS,22072270,CDM,329,RC,72270,HCPCS,OUTPATIENT,,,1440.00,576.00,,147.49,80,,,fee schedule,80% of Aetna fee schedule,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,553.17,272,,,fee schedule,272% of BCBS fee schedule,553.17,272,,,fee schedule,272% of BCBS fee schedule,553.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,864,60,,691.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,1224,85,,979.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,1008,70,,806.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,123.69,1224,
EPIDUROGRAPHY RS & I,22072275,CDM,329,RC,72275,HCPCS,OUTPATIENT,,,239.00,95.60,,91.01,80,,,fee schedule,80% of Aetna fee schedule,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.4,60,,114.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,167.3,70,,133.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,76.48,32,,61.18,percent of total billed charges,32% of total billed charges,76.48,203.15,
ELBOW RT ARTHOGRAM RS& I,22073085,CDM,322,RC,73085,HCPCS,OUTPATIENT,,,596.00,238.40,,72.64,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,72.64,506.6,
ELBOW  LT ARTHOGRAM RS& I,22073088,CDM,322,RC,73085,HCPCS,OUTPATIENT,,,596.00,238.40,LT,72.64,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,72.64,506.6,
INFANT LT UPR EXT 2V,22073092,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,160.00,64.00,,24.52,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,24.52,136,
WRIST  LT ARTHOGRAM RS & I,22073111,CDM,322,RC,73115,HCPCS,OUTPATIENT,,,596.00,238.40,,84.51,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,143.4,272,,,fee schedule,272% of BCBS fee schedule,143.4,272,,,fee schedule,272% of BCBS fee schedule,143.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,135.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,84.51,506.6,
WRIST  RT ARTHOGRAM RS & I,22073115,CDM,322,RC,73115,HCPCS,OUTPATIENT,,,596.00,238.40,,84.51,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,143.4,272,,,fee schedule,272% of BCBS fee schedule,143.4,272,,,fee schedule,272% of BCBS fee schedule,143.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,135.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,84.51,506.6,
HIP ARTHOGRAM RT RS & I,22073525,CDM,322,RC,73525,HCPCS,OUTPATIENT,,,984.00,393.60,,77.11,80,,,fee schedule,80% of Aetna fee schedule,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,590.4,60,,472.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,836.4,85,,669.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,688.8,70,,551.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,77.11,836.4,
KNEE RIGHT LIMITED 2V,22073560,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,167.00,66.80,,23.78,80,,,fee schedule,80% of Aetna fee schedule,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,23.78,141.95,
KNEE LEFT LIMITED 2 V,22073561,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,167.00,66.80,,23.78,80,,,fee schedule,80% of Aetna fee schedule,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,23.78,141.95,
KNEE BILAT STANDING AP,22073565,CDM,320,RC,73565,HCPCS,OUTPATIENT,,,101.00,40.40,,27.36,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,27.36,85.85,
KNEE  ARTHROGRAM RT PROCEDURE RS&I,22073580,CDM,322,RC,73580,HCPCS,OUTPATIENT,,,596.00,238.40,,104.3,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,147.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,104.3,506.6,
ANKLE ARTHROGRAM RS & I,22073615,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,816.00,326.40,LT,25.3,80,,,fee schedule,80% of Aetna fee schedule,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,489.6,60,,391.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,693.6,85,,554.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,571.2,70,,456.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,261.12,32,,208.9,percent of total billed charges,32% of total billed charges,25.3,693.6,
ABDOMEN COMPLETE W/ PA CHEST,22074022,CDM,320,RC,74022,HCPCS,OUTPATIENT,,,291.00,116.40,,35.5,80,,,fee schedule,80% of Aetna fee schedule,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,174.6,60,,139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,203.7,70,,162.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,35.5,247.35,
MODIFIED BARIUM SWALLOWING STUDY,22074230,CDM,320,RC,74230,HCPCS,OUTPATIENT,,,250.00,100.00,,68.03,80,,,fee schedule,80% of Aetna fee schedule,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,127.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,68.03,212.5,
CHILD NOSE TO RECTUM FOR FB,22076010,CDM,320,RC,76010,HCPCS,OUTPATIENT,,,131.00,52.40,,19.96,80,,,fee schedule,80% of Aetna fee schedule,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,19.96,111.35,
X-RAY UNLISTED PROCEDURE,22076499,CDM,320,RC,76499,HCPCS,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
FLUORO GUIDED NEEDLE PLACEMENT,22077002,CDM,320,RC,77002,HCPCS,OUTPATIENT,,,555.00,222.00,,58.34,80,,,fee schedule,80% of Aetna fee schedule,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,109.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,58.34,471.75,
US LT STEREOTACTIC LOCALIZATION,22077031,CDM,401,RC,19285,HCPCS,OUTPATIENT,,,716.00,286.40,,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,429.6,60,,343.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,474.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,608.6,85,,486.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,501.2,70,,400.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,608.6,
US RT STEREOTACTIC LOCALIZATION,22077033,CDM,401,RC,77031,HCPCS,OUTPATIENT,,,716.00,286.40,,99.84,80,,,fee schedule,80% of Aetna fee schedule,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,429.6,60,,343.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,608.6,85,,486.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,501.2,70,,400.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,99.84,608.6,
MM BIL STEREOTACTIC LOCALIZATION,22077034,CDM,401,RC,19283,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,162.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,312,
BRONCHOGRAM UNIL LT RS&I,22077040,CDM,324,RC,76499,HCPCS,OUTPATIENT,,,688.00,275.20,,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.8,60,,330.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,481.6,70,,385.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,32,,176.13,percent of total billed charges,32% of total billed charges,220.16,584.8,
US ECHOENCEPHLOGRAPHY,22077050,CDM,402,RC,76506,HCPCS,OUTPATIENT,,,489.00,195.60,,91.05,80,,,fee schedule,80% of Aetna fee schedule,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,293.4,60,,234.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,104.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,91.05,415.65,
SCANOGRAM,22077073,CDM,320,RC,77073,HCPCS,OUTPATIENT,,,177.00,70.80,,29.96,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,29.96,150.45,
INFANT SKELETAL SURVEY,22077076,CDM,320,RC,77076,HCPCS,OUTPATIENT,,,160.00,64.00,,78.4,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
BONE DENSITY DXA AXIAL,22077080,CDM,329,RC,77080,HCPCS,OUTPATIENT,,,348.00,139.20,,75.52,80,,,fee schedule,80% of Aetna fee schedule,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,281.14,272,,,fee schedule,272% of BCBS fee schedule,281.14,272,,,fee schedule,272% of BCBS fee schedule,281.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,208.8,60,,167.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,295.8,85,,236.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,243.6,70,,194.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,111.36,32,,89.09,percent of total billed charges,32% of total billed charges,33.51,295.8,
BONE DENSITY DXA LIMITED,22077081,CDM,329,RC,77081,HCPCS,OUTPATIENT,,,165.00,66.00,,22.33,80,,,fee schedule,80% of Aetna fee schedule,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,149.63,272,,,fee schedule,272% of BCBS fee schedule,149.63,272,,,fee schedule,272% of BCBS fee schedule,149.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,22.33,149.63,
DYSPHAGIA EVALUATION,22092610,CDM,440,RC,92610,HCPCS,OUTPATIENT,,,205.00,82.00,,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123,60,,98.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,143.5,70,,114.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,174.25,
MODIFIED BARIUM SWALLOW,22092611,CDM,440,RC,92611,HCPCS,OUTPATIENT,,,295.00,118.00,,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177,60,,141.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,115.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,206.5,70,,165.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,94.4,32,,75.52,percent of total billed charges,32% of total billed charges,94.4,250.75,
MM SCREEN OCT BREAST MONTH,22102012,CDM,403,RC,,,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
AC JOINTS,22800011,CDM,320,RC,73050,HCPCS,OUTPATIENT,,,130.00,52.00,,30.22,80,,,fee schedule,80% of Aetna fee schedule,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,23.76,110.5,
ANKLE RIGHT LIMIT 2V,22800029,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,177.00,70.80,RT,21.71,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,21.71,150.45,
ANKLE RT COMPLETE 3V,22800037,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,177.00,70.80,RT,25.3,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,25.3,150.45,
CLAVICLE RIGHT,22800045,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,177.00,70.80,RT,21.97,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,21.97,150.45,
ELBOW RIGHT 2V,22800052,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,132.00,52.80,RT,21.44,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.44,112.2,
ELBOW RIGHT COMPLETE,22800060,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,268.00,107.20,RT,25.05,80,,,fee schedule,80% of Aetna fee schedule,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,160.8,60,,128.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,25.05,227.8,
FEMUR RIGHT,22800078,CDM,320,RC,73552,HCPCS,OUTPATIENT,,,132.00,52.80,RT,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,32.3,112.2,
FINGER RIGHT 2-3V,22800086,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,101.00,40.40,RT,24.98,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,24.98,85.85,
FOOT RIGHT 2V (AP & LAT),22800094,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,101.00,40.40,RT,21.21,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,21.21,85.85,
FOOT RIGHT 2V,22800102,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,132.00,52.80,RT,21.21,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.21,112.2,
FOOT RIGHT COMPLETE 3V,22800110,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,220.00,88.00,RT,23.78,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,23.78,187,
FOOT LEFT COMPLETE 3V,22800111,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,220.00,88.00,,23.78,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,23.78,187,
FOREARM RIGHT,22800128,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,132.00,52.80,RT,20.95,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,20.95,112.2,
HAND RIGHT 3V,22800136,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,132.00,52.80,RT,24.54,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,24.54,112.2,
**** DUP CHG HEEL OS CALCIS RIGHT,22800144,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,188.00,75.20,RT,21.71,80,,,fee schedule,80% of Aetna fee schedule,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,112.8,60,,90.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,131.6,70,,105.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,60.16,32,,48.13,percent of total billed charges,32% of total billed charges,21.71,159.8,
HEEL OS CALCIS RIGHT,22800145,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,132.00,52.80,RT,21.71,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.71,112.2,
HIP L 1V W/AP PELVIS,22800150,CDM,320,RC,73501,HCPCS,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,45.12,272,,,fee schedule,272% of BCBS fee schedule,45.12,272,,,fee schedule,272% of BCBS fee schedule,45.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,28.64,150.45,
HIP RT 2-3V W/AP PELVIS,22800151,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,177.00,70.80,RT,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,44.08,150.45,
HIP BILAT 2V W/AP PELVIS,22800168,CDM,320,RC,73521,HCPCS,OUTPATIENT,,,291.00,116.40,,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,174.6,60,,139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,203.7,70,,162.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,37.18,247.35,
HIP BILAT W/AP PELVIS 5V,22800169,CDM,320,RC,73523,HCPCS,OUTPATIENT,,,555.00,222.00,,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,56.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,56.68,471.75,
HIP BILAT 3-4V W/AP PELVIS,22800170,CDM,320,RC,73522,HCPCS,OUTPATIENT,,,291.00,116.40,,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,174.6,60,,139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,203.7,70,,162.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,48.14,247.35,
HIP R 1V W/AP PELVIS,22800171,CDM,320,RC,73501,HCPCS,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,45.12,272,,,fee schedule,272% of BCBS fee schedule,45.12,272,,,fee schedule,272% of BCBS fee schedule,45.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,28.64,150.45,
HIP RT 4V W/AP PELVIS,22800177,CDM,320,RC,73503,HCPCS,OUTPATIENT,,,291.00,116.40,RT,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,174.6,60,,139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,203.7,70,,162.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,54.75,247.35,
HIP RT 1V W/AP PELVIS,22800185,CDM,320,RC,73501,HCPCS,OUTPATIENT,,,177.00,70.80,RT,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,45.12,272,,,fee schedule,272% of BCBS fee schedule,45.12,272,,,fee schedule,272% of BCBS fee schedule,45.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,28.64,150.45,
HUMERUS RIGHT,22800193,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,132.00,52.80,RT,21.98,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.98,112.2,
KNEE RIGHT 3 V,22800201,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,132.00,52.80,,28.66,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,28.66,112.2,
KNEE RT COMPLETE 4V,22800219,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,132.00,52.80,RT,33.06,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,33.06,112.2,
INFANT RT LWR EXT,22800227,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,137.00,54.80,,25.29,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,25.29,116.45,
TIBIA/FIBULA RIGHT,22800235,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,132.00,52.80,RT,20.71,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,20.71,112.2,
SCAPULA RIGHT,22800243,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,132.00,52.80,RT,24.04,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,18.49,112.2,
SHOULDER RIGHT,22800250,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,132.00,52.80,RT,23.81,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,23.81,112.2,
TOE RIGHT,22800268,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,101.00,40.40,RT,22.94,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,22.94,85.85,
INFANT RT UPR EXT 2V,22800276,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,160.00,64.00,,24.52,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,24.52,136,
WRIST RIGHT LIMIT 2V,22800284,CDM,320,RC,73100,HCPCS,OUTPATIENT,,,175.00,70.00,,24.54,80,,,fee schedule,80% of Aetna fee schedule,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,24.54,148.75,
WRIST RIGHT COMP,22800292,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,175.00,70.00,RT,28.11,80,,,fee schedule,80% of Aetna fee schedule,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,28.11,148.75,
BARIUM ENEMA COLON,22800409,CDM,320,RC,74270,HCPCS,OUTPATIENT,,,365.00,146.00,,115.9,80,,,fee schedule,80% of Aetna fee schedule,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,155.12,272,,,fee schedule,272% of BCBS fee schedule,155.12,272,,,fee schedule,272% of BCBS fee schedule,155.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,219,60,,175.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,133.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,255.5,70,,204.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,115.9,310.25,
BARIUM ENEMA W AIR,22800417,CDM,320,RC,74280,HCPCS,OUTPATIENT,,,501.00,200.40,,160.69,80,,,fee schedule,80% of Aetna fee schedule,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,203.37,272,,,fee schedule,272% of BCBS fee schedule,203.37,272,,,fee schedule,272% of BCBS fee schedule,203.37,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,300.6,60,,240.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,204.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,350.7,70,,280.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,425.85,
CHOLANGIOGRAM W/TOMOS,22800425,CDM,320,RC,74305,HCPCS,OUTPATIENT,,,381.00,152.40,,,,,,other ,not seperately reimbursable,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.6,60,,182.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,266.7,70,,213.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,121.92,32,,97.54,percent of total billed charges,32% of total billed charges,121.92,323.85,
CT UROGRAM,22800433,CDM,352,RC,74176,HCPCS,OUTPATIENT,,,1180.00,472.00,,766.94,100,,,case rate,pays based on per visit rate,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,708,60,,566.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1003,85,,802.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,826,70,,660.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,130.6,1050.3,
ESOPHAGRAM,22800441,CDM,320,RC,74220,HCPCS,OUTPATIENT,,,250.00,100.00,,67.4,80,,,fee schedule,80% of Aetna fee schedule,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,107.33,272,,,fee schedule,272% of BCBS fee schedule,107.33,272,,,fee schedule,272% of BCBS fee schedule,107.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,67.4,212.5,
GB SERIES,22800458,CDM,320,RC,74290,HCPCS,OUTPATIENT,,,75.00,30.00,,51.84,80,,,fee schedule,80% of Aetna fee schedule,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,89.58,
HYPOTONIC DUODENOGRAPH,22800466,CDM,320,RC,74251,HCPCS,OUTPATIENT,,,885.00,354.00,,220.35,80,,,fee schedule,80% of Aetna fee schedule,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,531,60,,424.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,229.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,752.25,85,,601.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,619.5,70,,495.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,118.18,752.25,
IV CHOLANGIOGRAM,22800474,CDM,320,RC,74305,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
OR CHOLANGIOGRAM,22800482,CDM,320,RC,74300,HCPCS,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,70.64,272,,,fee schedule,272% of BCBS fee schedule,70.64,272,,,fee schedule,272% of BCBS fee schedule,70.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
SMALL BOWEL SERIES,22800490,CDM,320,RC,74250,HCPCS,OUTPATIENT,,,255.00,102.00,,80.44,80,,,fee schedule,80% of Aetna fee schedule,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,153,60,,122.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,178.5,70,,142.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,81.6,32,,65.28,percent of total billed charges,32% of total billed charges,80.44,216.75,
T TUBE CHOLANGIOGRAM,22800508,CDM,361,RC,47531,HCPCS,OUTPATIENT,,,6900.00,2760.00,,3000,100,,,case rate,pays based on per visit rate,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4140,60,,3312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,541.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,5865,85,,4692,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,4830,70,,3864,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,2208,32,,1766.4,percent of total billed charges,32% of total billed charges,541.55,5865,
UGI SERIES W/AIR HDBA,22800516,CDM,320,RC,74246,HCPCS,OUTPATIENT,,,285.00,114.00,,94.98,80,,,fee schedule,80% of Aetna fee schedule,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,149.49,272,,,fee schedule,272% of BCBS fee schedule,149.49,272,,,fee schedule,272% of BCBS fee schedule,149.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,171,60,,136.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,199.5,70,,159.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,242.25,
UGI W/SMALL BOWEL,22800524,CDM,320,RC,74240,HCPCS,OUTPATIENT,,,415.00,166.00,,85.02,80,,,fee schedule,80% of Aetna fee schedule,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.55,272,,,fee schedule,272% of BCBS fee schedule,132.55,272,,,fee schedule,272% of BCBS fee schedule,132.55,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,249,60,,199.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,352.75,85,,282.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,290.5,70,,232.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,132.8,32,,106.24,percent of total billed charges,32% of total billed charges,85.02,352.75,
GASTROGRAFIN,22800560,CDM,255,RC,,,OUTPATIENT,,,259.00,103.60,,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.4,60,,124.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,181.3,70,,145.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,32,,66.3,percent of total billed charges,32% of total billed charges,82.88,220.15,
GASTROVIEW,22800569,CDM,255,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
ANKLE LEFT LIMIT 2V,22800570,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,177.00,70.80,LT,21.71,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,21.71,150.45,
ANKLE LT COMPLETE 3V,22800571,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,177.00,70.80,LT,25.3,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,25.3,150.45,
CLAVICLE LEFT,22800572,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,177.00,70.80,LT,21.97,80,,,fee schedule,80% of Aetna fee schedule,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,21.97,150.45,
ELBOW LEFT 2V,22800573,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,132.00,52.80,LT,21.44,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.44,112.2,
ELBOW LEFT 3V,22800574,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,268.00,107.20,LT,25.05,80,,,fee schedule,80% of Aetna fee schedule,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,160.8,60,,128.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,187.6,70,,150.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,85.76,32,,68.61,percent of total billed charges,32% of total billed charges,25.05,227.8,
INFANT LT LWR EXT,22800575,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,137.00,54.80,,25.29,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,25.29,116.45,
FEMUR LEFT,22800576,CDM,320,RC,73552,HCPCS,OUTPATIENT,,,132.00,52.80,LT,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,32.3,112.2,
FINGER LEFT 2-3V,22800577,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,101.00,40.40,LT,24.98,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,24.98,85.85,
FOOT LEFT 2V (AP & LAT),22800578,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,50.00,20.00,LT,21.21,80,,,fee schedule,80% of Aetna fee schedule,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,44.77,
FOOT LEFT 2V,22800579,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,132.00,52.80,LT,21.21,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.21,112.2,
FOOT LEFT LIMIT 2V,22800580,CDM,320,RC,73620,HCPCS,OUTPATIENT,,,132.00,52.80,LT,21.21,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.21,112.2,
FOREARM LEFT,22800581,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,132.00,52.80,LT,20.95,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,20.95,112.2,
HAND LEFT 3V,22800582,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,132.00,52.80,LT,24.54,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,24.54,112.2,
HEEL OS CALCIS LEFT,22800583,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,132.00,52.80,LT,21.71,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.71,112.2,
HIP LT 2-3V W/PELVIS,22800584,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,177.00,70.80,LT,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,44.08,150.45,
INFANT/CHILD PELVIS & FROG,22800586,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,132.00,52.80,LT,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
HUMERUS LEFT,22800587,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,132.00,52.80,LT,21.98,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.98,112.2,
KNEE LEFT 3V,22800588,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,132.00,52.80,,28.66,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,28.66,112.2,
KNEE LT COMPLETE 4V,22800589,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,132.00,52.80,LT,33.06,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,33.06,112.2,
TIBIA/FIBULA LEFT,22800590,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,132.00,52.80,LT,20.71,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,20.71,112.2,
RIBS LT/PA CHEST 3V,22800591,CDM,320,RC,71101,HCPCS,OUTPATIENT,,,315.00,126.00,LT,29.55,80,,,fee schedule,80% of Aetna fee schedule,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,189,60,,151.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,29.55,267.75,
SCAPULA LEFT,22800592,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,132.00,52.80,LT,24.04,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,18.49,112.2,
SHOULDER LEFT,22800593,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,132.00,52.80,LT,23.81,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,23.81,112.2,
TOE LEFT,22800594,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,101.00,40.40,LT,22.94,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,22.94,85.85,
WRIST LEFT LIMIT 2V,22800596,CDM,320,RC,73100,HCPCS,OUTPATIENT,,,175.00,70.00,LT,24.54,80,,,fee schedule,80% of Aetna fee schedule,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,24.54,148.75,
WRIST LEFT COMP,22800597,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,175.00,70.00,LT,28.11,80,,,fee schedule,80% of Aetna fee schedule,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,28.11,148.75,
ABDOMEN 2V,22800607,CDM,320,RC,74019,HCPCS,OUTPATIENT,,,175.00,70.00,,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,31.49,148.75,
ABDOMEN 3V,22800608,CDM,320,RC,74021,HCPCS,OUTPATIENT,,,216.00,86.40,,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,56.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,129.6,60,,103.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,151.2,70,,120.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,37.18,183.6,
CYSTOGRAM,22800615,CDM,320,RC,74430,HCPCS,OUTPATIENT,,,453.00,181.20,,30.4,80,,,fee schedule,80% of Aetna fee schedule,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,271.8,60,,217.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,385.05,85,,308.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,317.1,70,,253.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,30.4,385.05,
IVP DRIP W/TOMOS,22800631,CDM,320,RC,74415,HCPCS,OUTPATIENT,,,212.00,84.80,,100.12,80,,,fee schedule,80% of Aetna fee schedule,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,192.49,272,,,fee schedule,272% of BCBS fee schedule,192.49,272,,,fee schedule,272% of BCBS fee schedule,192.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,127.2,60,,101.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,148.4,70,,118.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,192.49,
IVP W/SCOUT FILM,22800649,CDM,320,RC,74400,HCPCS,OUTPATIENT,,,535.00,214.00,,82.26,80,,,fee schedule,80% of Aetna fee schedule,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,153.41,272,,,fee schedule,272% of BCBS fee schedule,153.41,272,,,fee schedule,272% of BCBS fee schedule,153.41,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,321,60,,256.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,140.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,374.5,70,,299.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,82.26,454.75,
IVP W/TOMOS,22800656,CDM,320,RC,74415,HCPCS,OUTPATIENT,,,212.00,84.80,,100.12,80,,,fee schedule,80% of Aetna fee schedule,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,192.49,272,,,fee schedule,272% of BCBS fee schedule,192.49,272,,,fee schedule,272% of BCBS fee schedule,192.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,127.2,60,,101.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,148.4,70,,118.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,192.49,
ABDOMEN 1V (KUB),22800664,CDM,320,RC,74018,HCPCS,OUTPATIENT,,,175.00,70.00,,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,105,60,,84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,122.5,70,,98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56,32,,44.8,percent of total billed charges,32% of total billed charges,56,32,,44.8,percent of total billed charges,32% of total billed charges,26.2,148.75,
PELVIMETRY 2V,22800672,CDM,320,RC,74000,HCPCS,OUTPATIENT,,,52.00,20.80,,18.18,80,,,fee schedule,80% of Aetna fee schedule,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
IVP HYPER W/TOMOS,22800680,CDM,320,RC,74400,HCPCS,OUTPATIENT,,,169.00,67.60,,82.26,80,,,fee schedule,80% of Aetna fee schedule,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,153.41,272,,,fee schedule,272% of BCBS fee schedule,153.41,272,,,fee schedule,272% of BCBS fee schedule,153.41,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,101.4,60,,81.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,140.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,118.3,70,,94.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,32,,43.26,percent of total billed charges,32% of total billed charges,54.08,153.41,
OMNISCAN 20ML,22800697,CDM,255,RC,A9579,HCPCS,OUTPATIENT,,,214.00,85.60,,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.4,60,,102.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,181.9,85,,145.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,149.8,70,,119.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,181.9,
FACIAL BONES COMPLETE,22800805,CDM,320,RC,70150,HCPCS,OUTPATIENT,,,160.00,64.00,,31.83,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,31.83,136,
INTERNAL AUDITORY MEATUS,22800813,CDM,320,RC,70134,HCPCS,OUTPATIENT,,,220.00,88.00,,34.26,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,54.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,34.26,187,
MANDIBLE RT 3 VIEWS,22800821,CDM,320,RC,70100,HCPCS,OUTPATIENT,,,132.00,52.80,,26.09,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,26.09,112.2,
MASTOIDS 3 VIEWS EACH SIDE,22800839,CDM,320,RC,70120,HCPCS,OUTPATIENT,,,132.00,52.80,,27.11,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,27.11,112.2,
NASAL BONES,22800847,CDM,320,RC,70160,HCPCS,OUTPATIENT,,,132.00,52.80,,24.79,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,24.79,112.2,
ORBITS 4 VIEWS,22800854,CDM,320,RC,70200,HCPCS,OUTPATIENT,,,132.00,52.80,,32.38,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,32.38,112.2,
SINUSES PARANASAL,22800862,CDM,320,RC,70220,HCPCS,OUTPATIENT,,,132.00,52.80,,29.26,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,29.26,112.2,
SKULL COMPLETE,22800870,CDM,320,RC,70260,HCPCS,OUTPATIENT,,,220.00,88.00,,35.29,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,35.29,187,
TMJ'S UNILAT RT OPEN & CLOSED MOUTH,22800888,CDM,320,RC,70328,HCPCS,OUTPATIENT,,,174.00,69.60,,23.28,80,,,fee schedule,80% of Aetna fee schedule,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,23.28,147.9,
ARTHROGRAM PROCEDURE SHOULDER RT,22801001,CDM,322,RC,73040,HCPCS,OUTPATIENT,,,596.00,238.40,,79.41,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,129.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,79.41,506.6,
BRONCHOGRAM PROCEDURE,22801019,CDM,324,RC,,,OUTPATIENT,,,471.00,188.40,,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.6,60,,226.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,329.7,70,,263.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,400.35,
MM SCREENING BILA DIGITAL,22801035,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,431.00,172.40,,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.4,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,112.31,366.35,
MM CAD COMPUTER AIDED DIAG-DIGITAL LT,22801040,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,30,
MM CAD COMPUTER AIDED DIAG-DIGITAL RT,22801041,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,30,
MM CAD COMPUTER AIDED DIAG-DIGITAL BILAT,22801042,CDM,401,RC,77066,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,30,
METASTATIC BONE SERIES,22801043,CDM,320,RC,77074,HCPCS,OUTPATIENT,,,225.00,90.00,,51.56,80,,,fee schedule,80% of Aetna fee schedule,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,90.39,272,,,fee schedule,272% of BCBS fee schedule,90.39,272,,,fee schedule,272% of BCBS fee schedule,90.39,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,135,60,,108,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,54.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,157.5,70,,126,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,51.56,191.25,
MM CAD COMPUTER AIDED SCREENING-DIGITAL,22801045,CDM,403,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
MYELOGRAM C SP,22801050,CDM,329,RC,72240,HCPCS,OUTPATIENT,,,1050.00,420.00,,96.75,80,,,fee schedule,80% of Aetna fee schedule,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,430.63,272,,,fee schedule,272% of BCBS fee schedule,430.63,272,,,fee schedule,272% of BCBS fee schedule,430.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,630,60,,504,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,892.5,85,,714,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,735,70,,588,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,87.95,892.5,
MYELOGRAM T SPINE,22801068,CDM,329,RC,72255,HCPCS,OUTPATIENT,,,1050.00,420.00,,94.32,80,,,fee schedule,80% of Aetna fee schedule,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,392.82,272,,,fee schedule,272% of BCBS fee schedule,392.82,272,,,fee schedule,272% of BCBS fee schedule,392.82,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,630,60,,504,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,892.5,85,,714,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,735,70,,588,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,336,32,,268.8,percent of total billed charges,32% of total billed charges,336,32,,268.8,percent of total billed charges,32% of total billed charges,89.58,892.5,
PACEMAKER OR SWANZ SCAN RS&I,22801076,CDM,329,RC,76000,HCPCS,OUTPATIENT,,,275.00,110.00,,38.58,80,,,fee schedule,80% of Aetna fee schedule,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,33.93,233.75,
SINOGRAM SINUS TRACT INJ/SALIVARY GLAND,22801084,CDM,320,RC,70380,HCPCS,OUTPATIENT,,,137.00,54.80,,30.92,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,30.92,116.45,
**LAMINOGRAM TOMOS,22801092,CDM,320,RC,70380,HCPCS,OUTPATIENT,,,137.00,54.80,,30.92,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,30.92,116.45,
VENOGRAM UNILATERAL,22801100,CDM,320,RC,75822,HCPCS,OUTPATIENT,,,1146.00,458.40,,117.69,80,,,fee schedule,80% of Aetna fee schedule,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,134.29,272,,,fee schedule,272% of BCBS fee schedule,134.29,272,,,fee schedule,272% of BCBS fee schedule,134.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,687.6,60,,550.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,80.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,974.1,85,,779.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,802.2,70,,641.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,80.23,974.1,
VENOGRAM BILATERAL,22801118,CDM,320,RC,75822,HCPCS,OUTPATIENT,,,1146.00,458.40,,117.69,80,,,fee schedule,80% of Aetna fee schedule,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,134.29,272,,,fee schedule,272% of BCBS fee schedule,134.29,272,,,fee schedule,272% of BCBS fee schedule,134.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,687.6,60,,550.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,80.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,974.1,85,,779.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,802.2,70,,641.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,366.72,32,,293.38,percent of total billed charges,32% of total billed charges,80.23,974.1,
MM GUIDED NEEDLE PLACEMENT,22801126,CDM,401,RC,19283,HCPCS,OUTPATIENT,,,716.00,286.40,,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,429.6,60,,343.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,327.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,608.6,85,,486.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,501.2,70,,400.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,608.6,
HIP LT 4V W/AP PELVIS,22801177,CDM,320,RC,73503,HCPCS,OUTPATIENT,,,291.00,116.40,LT,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,174.6,60,,139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,203.7,70,,162.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,54.75,247.35,
C OR L SPINE 2V,22801209,CDM,320,RC,72040,HCPCS,OUTPATIENT,,,220.00,88.00,,30.25,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,30.25,187,
C SPINE LIMIT 3V,22801217,CDM,320,RC,72040,HCPCS,OUTPATIENT,,,132.00,52.80,,30.25,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,30.25,112.2,
C SPINE COMP 5V,22801225,CDM,320,RC,72050,HCPCS,OUTPATIENT,,,221.00,88.40,,39.59,80,,,fee schedule,80% of Aetna fee schedule,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132.6,60,,106.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,154.7,70,,123.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,70.72,32,,56.58,percent of total billed charges,32% of total billed charges,39.59,187.85,
SPINE ENTIRE STD AP/LAT,22801233,CDM,320,RC,72010,HCPCS,OUTPATIENT,,,220.00,88.00,,58.71,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,58.71,187,
L SPINE 2-3V,22801241,CDM,320,RC,72100,HCPCS,OUTPATIENT,,,288.00,115.20,,31.53,80,,,fee schedule,80% of Aetna fee schedule,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,172.8,60,,138.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,201.6,70,,161.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,31.53,244.8,
L SPINE 6V,22801255,CDM,320,RC,72114,HCPCS,OUTPATIENT,,,350.00,140.00,,56.9,80,,,fee schedule,80% of Aetna fee schedule,112,32,,89.6,percent of total billed charges,32% of total billed charges,112,32,,89.6,percent of total billed charges,32% of total billed charges,107.33,272,,,fee schedule,272% of BCBS fee schedule,107.33,272,,,fee schedule,272% of BCBS fee schedule,107.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,210,60,,168,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,57.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,112,32,,89.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,32,,89.6,percent of total billed charges,32% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,32,,89.6,percent of total billed charges,32% of total billed charges,112,32,,89.6,percent of total billed charges,32% of total billed charges,245,70,,196,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,112,32,,89.6,percent of total billed charges,32% of total billed charges,112,32,,89.6,percent of total billed charges,32% of total billed charges,56.9,297.5,
L SPINE  4- 5V,22801258,CDM,320,RC,72110,HCPCS,OUTPATIENT,,,320.00,128.00,,41.89,80,,,fee schedule,80% of Aetna fee schedule,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,83.42,272,,,fee schedule,272% of BCBS fee schedule,83.42,272,,,fee schedule,272% of BCBS fee schedule,83.42,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,192,60,,153.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,272,85,,217.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,224,70,,179.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,41.89,272,
PELVIS AP 1 OR 2 V,22801266,CDM,320,RC,72170,HCPCS,OUTPATIENT,,,132.00,52.80,,20.73,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,20.73,112.2,
SI JOINTS 3 + V,22801274,CDM,320,RC,72202,HCPCS,OUTPATIENT,,,132.00,52.80,,25.34,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,25.34,112.2,
SACRUM/COCCYX,22801282,CDM,320,RC,72220,HCPCS,OUTPATIENT,,,132.00,52.80,,21.48,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,52.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,21.48,112.2,
T SPINE 3V,22801290,CDM,320,RC,72072,HCPCS,OUTPATIENT,,,160.00,64.00,,27.43,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,27.43,136,
MM NEEDLE LOC,22801308,CDM,401,RC,19283,HCPCS,OUTPATIENT,,,196.00,78.40,,,,,,other ,not seperately reimbursable,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,117.6,60,,94.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,245,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,137.2,70,,109.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,62.72,32,,50.18,percent of total billed charges,32% of total billed charges,62.72,312,
CHEST SPORTCRAFT EMPLOYEE,22801399,CDM,324,RC,71010,HCPCS,OUTPATIENT,,,137.00,54.80,,17.41,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,17.41,116.45,
CHEST 1V,22801407,CDM,324,RC,71045,HCPCS,OUTPATIENT,,,133.00,53.20,,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.8,60,,63.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,20.93,113.05,
CHEST 2V,22801415,CDM,324,RC,71046,HCPCS,OUTPATIENT,,,213.00,85.20,,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,55.41,272,,,fee schedule,272% of BCBS fee schedule,55.41,272,,,fee schedule,272% of BCBS fee schedule,55.41,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,127.8,60,,102.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,149.1,70,,119.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,28.24,181.05,
CHEST 3V,22801423,CDM,324,RC,71047,HCPCS,OUTPATIENT,,,315.00,126.00,,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,49.86,272,,,fee schedule,272% of BCBS fee schedule,49.86,272,,,fee schedule,272% of BCBS fee schedule,49.86,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,189,60,,151.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,35.95,267.75,
RIBS RT/PA CHEST 3V,22801431,CDM,320,RC,71101,HCPCS,OUTPATIENT,,,315.00,126.00,,29.55,80,,,fee schedule,80% of Aetna fee schedule,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,189,60,,151.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,29.55,267.75,
RIBS BILAT /PA CHEST,22801449,CDM,320,RC,71111,HCPCS,OUTPATIENT,,,450.00,180.00,,39.34,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,81.71,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,45.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,39.34,382.5,
SC JOINTS,22801456,CDM,320,RC,71130,HCPCS,OUTPATIENT,,,132.00,52.80,,27.43,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,63.43,272,,,fee schedule,272% of BCBS fee schedule,63.43,272,,,fee schedule,272% of BCBS fee schedule,63.43,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,27.43,112.2,
STERNUM,22801464,CDM,320,RC,71120,HCPCS,OUTPATIENT,,,132.00,52.80,,23.31,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,59.11,272,,,fee schedule,272% of BCBS fee schedule,59.11,272,,,fee schedule,272% of BCBS fee schedule,59.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,23.31,112.2,
MANDIBLE 3 VIEWS,22801821,CDM,320,RC,70100,HCPCS,OUTPATIENT,,,137.00,54.80,,26.09,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,26.09,116.45,
CHEST BUCKEYE SINGLE VIEW,22802025,CDM,324,RC,71010,HCPCS,OUTPATIENT,,,137.00,54.80,,17.41,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,17.41,116.45,
HOSPITAL VISIT-RADIOLOGIST,22802504,CDM,320,RC,,,OUTPATIENT,,,174.00,69.60,,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,147.9,
LUMBAR PUNCTURE,22803095,CDM,360,RC,62270,HCPCS,OUTPATIENT,,,246.00,98.40,,3000,100,,,case rate,pays based on per visit rate,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,147.6,60,,118.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,160.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,172.2,70,,137.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,3000,
OMNIPAQUE 50ML,22803926,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
VISIPAQUE 50M,22804025,CDM,255,RC,Q9965,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
VISIPAQUE 270 - 100 ML BOTTLE,22804032,CDM,255,RC,,,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
OMNIPAQUE 100ML,22804280,CDM,255,RC,Q9967,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
ABDOMINAL AORTA,22804476,CDM,320,RC,75625,HCPCS,OUTPATIENT,,,1182.00,472.80,,118.74,80,,,fee schedule,80% of Aetna fee schedule,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,709.2,60,,567.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,1004.7,85,,803.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,827.4,70,,661.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,378.24,32,,302.59,percent of total billed charges,32% of total billed charges,74.14,1141.56,
ABDOMEN 3V,22804492,CDM,320,RC,74022,HCPCS,OUTPATIENT,,,75.00,30.00,,35.5,80,,,fee schedule,80% of Aetna fee schedule,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,67.35,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,67.35,
IUD LOCALIZATION,22804500,CDM,320,RC,72170,HCPCS,OUTPATIENT,,,220.00,88.00,,20.73,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,23.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,20.73,187,
UNLISTED SCANS,22804583,CDM,320,RC,,,OUTPATIENT,,,462.00,184.80,,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.2,60,,221.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,392.7,85,,314.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,323.4,70,,258.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,392.7,
EMERGENCY CALL CT,22804591,CDM,350,RC,,,OUTPATIENT,,,,,,600,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,600,
MM GALACTOGRAM,22804593,CDM,320,RC,77053,HCPCS,OUTPATIENT,,,559.00,223.60,,42.72,80,,,fee schedule,80% of Aetna fee schedule,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,335.4,60,,268.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,42.72,475.15,
MM RT DIAG UNILATERAL DIGITAL,22804594,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,287.00,114.80,RT,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.2,60,,137.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,200.9,70,,160.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,243.95,
MM F/U  RT(UNI DIAG),22804595,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,359.00,143.60,RT,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215.4,60,,172.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,251.3,70,,201.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,106.63,305.15,
MM RT SCREENING UNILAT DIGITAL,22804596,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,431.00,172.40,RT52,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.4,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,112.31,366.35,
DO NOT CHARGE BEDSIDE PORTABLE,22804609,CDM,320,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
HAWKINS II 20X7.5CM,22804614,CDM,272,RC,,,OUTPATIENT,,,770.00,308.00,,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,462,60,,369.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,308,40,,246.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,654.5,85,,523.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,539,70,,431.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,32,,197.12,percent of total billed charges,32% of total billed charges,246.4,654.5,
JABCZENSKI DUCTOGRAM CANNULA,22804616,CDM,401,RC,77053,HCPCS,OUTPATIENT,,,690.00,276.00,,42.72,80,,,fee schedule,80% of Aetna fee schedule,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,414,60,,331.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,44.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,483,70,,386.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,42.72,586.5,
MM BREAST BIOPSY NEEDLE,22804617,CDM,320,RC,19081,HCPCS,OUTPATIENT,,,3663.00,1465.20,,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2197.8,60,,1758.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,638.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,3113.55,85,,2490.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,2564.1,70,,2051.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,638.85,3113.55,
CATH DRAIN 8FR LOCK,22804618,CDM,272,RC,,,OUTPATIENT,,,494.00,197.60,,,,,,other ,not seperately reimbursable,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,296.4,60,,237.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,197.6,40,,158.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,345.8,70,,276.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,158.08,32,,126.46,percent of total billed charges,32% of total billed charges,158.08,419.9,
NEEDLE INTRODUCER SHEATH,22804619,CDM,272,RC,,,OUTPATIENT,,,145.00,58.00,,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87,60,,69.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58,40,,46.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,101.5,70,,81.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,123.25,
C SPINE COMPLETE W/FLEX & EXT,22805009,CDM,320,RC,72052,HCPCS,OUTPATIENT,,,250.00,100.00,,50.65,80,,,fee schedule,80% of Aetna fee schedule,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,102.98,272,,,fee schedule,272% of BCBS fee schedule,102.98,272,,,fee schedule,272% of BCBS fee schedule,102.98,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,58.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,50.65,212.5,
FLUORO not part of procedure 0-60 MIN,22805011,CDM,320,RC,77001,HCPCS,OUTPATIENT,,,555.00,222.00,,88.2,80,,,fee schedule,80% of Aetna fee schedule,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,103.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,88.2,471.75,
BONE AGE,22805013,CDM,320,RC,77072,HCPCS,OUTPATIENT,,,131.00,52.40,,17.68,80,,,fee schedule,80% of Aetna fee schedule,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,78.6,60,,62.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,91.7,70,,73.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,41.92,32,,33.54,percent of total billed charges,32% of total billed charges,17.68,111.35,
FLUORO LINE PLACEMENT,22805019,CDM,320,RC,77001,HCPCS,OUTPATIENT,,,555.00,222.00,,88.2,80,,,fee schedule,80% of Aetna fee schedule,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,103.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,88.2,471.75,
FLUORO 61 MIN PLUS,22805020,CDM,402,RC,76001,HCPCS,OUTPATIENT,,,555.00,222.00,,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,222,40,,177.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,471.75,
L SPINE 2V - 3V,22805025,CDM,320,RC,72100,HCPCS,OUTPATIENT,,,132.00,52.80,,31.53,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,60.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,31.53,112.2,
MM SPECIMEN RADIOGRAPH,22805030,CDM,401,RC,76098,HCPCS,OUTPATIENT,,,559.00,223.60,,13.54,80,,,fee schedule,80% of Aetna fee schedule,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,335.4,60,,268.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,13.54,475.15,
US LT SPECIMEN RADIOGRAPH,22805031,CDM,320,RC,19083,HCPCS,OUTPATIENT,,,3663.00,1465.20,,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2197.8,60,,1758.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,645.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,3113.55,85,,2490.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,2564.1,70,,2051.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,645.85,3113.55,
US RT SPECIMEN RADIOGRAPH,22805033,CDM,320,RC,19083,HCPCS,OUTPATIENT,,,3663.00,1465.20,,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2197.8,60,,1758.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,645.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,3113.55,85,,2490.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,2564.1,70,,2051.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,645.85,3113.55,
0CYST ASPIRATION,22805035,CDM,401,RC,,,OUTPATIENT,,,142.00,56.80,,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.2,60,,68.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,56.8,40,,45.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,120.7,
US BIL SPECIMEN RADIOGRAPH,22805038,CDM,320,RC,19083,HCPCS,OUTPATIENT,,,3663.00,1465.20,,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2197.8,60,,1758.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,645.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,3113.55,85,,2490.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,2564.1,70,,2051.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,645.85,3113.55,
GLUCAGON 1MG,22806031,CDM,255,RC,J1610,HCPCS,OUTPATIENT,,,147.00,58.80,,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,60,,70.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,102.9,70,,82.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,32,,37.63,percent of total billed charges,32% of total billed charges,47.04,124.95,
FLUORO<60 MIN,22806459,CDM,320,RC,76000,HCPCS,OUTPATIENT,,,555.00,222.00,,38.58,80,,,fee schedule,80% of Aetna fee schedule,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,33.93,471.75,
CONRAY DYE,22806943,CDM,254,RC,Q9958,HCPCS,OUTPATIENT,,,142.00,56.80,,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.2,60,,68.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,120.7,
PERCUTANEOUS NEPHROSTO,22808010,CDM,361,RC,49405,HCPCS,OUTPATIENT,,,2922.00,1168.80,,3000,100,,,case rate,pays based on per visit rate,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1753.2,60,,1402.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1131.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2483.7,85,,1986.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,2045.4,70,,1636.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,32,,748.03,percent of total billed charges,32% of total billed charges,935.04,3000,
SOFT TISSUE NECK LAT,22808241,CDM,320,RC,70360,HCPCS,OUTPATIENT,,,101.00,40.40,,20.71,80,,,fee schedule,80% of Aetna fee schedule,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,38.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,20.71,85.85,
CHEST AP PORTABLE,22809038,CDM,324,RC,71045,HCPCS,OUTPATIENT,,,133.00,53.20,,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,43.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.8,60,,63.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,20.93,113.05,
VOIDING CYSTOURETHROGRAM,22809046,CDM,320,RC,74455,HCPCS,OUTPATIENT,,,453.00,181.20,,63.34,80,,,fee schedule,80% of Aetna fee schedule,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,143.4,272,,,fee schedule,272% of BCBS fee schedule,143.4,272,,,fee schedule,272% of BCBS fee schedule,143.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,271.8,60,,217.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,111.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,385.05,85,,308.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,317.1,70,,253.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,144.96,32,,115.97,percent of total billed charges,32% of total billed charges,63.34,385.05,
RETROGRADE,22809079,CDM,320,RC,74420,HCPCS,OUTPATIENT,,,535.00,214.00,,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,239.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,321,60,,256.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,63.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,374.5,70,,299.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,171.2,32,,136.96,percent of total billed charges,32% of total billed charges,63.98,454.75,
US F/U (BIL DIAG)DIGITAL,22809080,CDM,401,RC,G0204,HCPCS,OUTPATIENT,,,302.00,120.80,,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.2,60,,144.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,211.4,70,,169.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,256.7,
PERCUTANEOUS PYELOGRAM,22809090,CDM,320,RC,74475,HCPCS,OUTPATIENT,,,2118.00,847.20,,73.15,80,,,fee schedule,80% of Aetna fee schedule,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1270.8,60,,1016.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,1800.3,85,,1440.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,1482.6,70,,1186.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,677.76,32,,542.21,percent of total billed charges,32% of total billed charges,73.15,1800.3,
US RT UNI DIAG DIGITAL MAMMO,22809094,CDM,401,RC,G0206,HCPCS,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,204,
MM DIAG BILATERAL,22809095,CDM,401,RC,77066,HCPCS,OUTPATIENT,,,431.00,172.40,,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,135.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,135.88,366.35,
MM F/U (BIL DIAG),22809096,CDM,401,RC,77066,HCPCS,OUTPATIENT,,,431.00,172.40,,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,135.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,135.88,366.35,
MM F/U  LT(UNI DIAG),22809097,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,359.00,143.60,LT,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215.4,60,,172.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,251.3,70,,201.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,106.63,305.15,
US LT UNI DIAG DIGITAL MAMMO,22809098,CDM,401,RC,G0206,HCPCS,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,204,
MM 3D DIAG RIGHT,22810000,CDM,401,RC,77061,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MM 3D DIAG LEFT,22810001,CDM,401,RC,77061,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MM 3D SCREENING RIGHT,22810002,CDM,403,RC,77063,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MM BREAST BIOPSY W/STEREO GUIDE 1ST LESI,22810003,CDM,320,RC,19081,HCPCS,OUTPATIENT,,,3663.00,1465.20,,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2197.8,60,,1758.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,638.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,3113.55,85,,2490.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,2564.1,70,,2051.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,1172.16,32,,937.73,percent of total billed charges,32% of total billed charges,638.85,3113.55,
MM BREAST BIOPSY W/STEREO GUIDE ADD LESI,22810004,CDM,401,RC,19082,HCPCS,OUTPATIENT,,,270.00,108.00,,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162,60,,129.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,337.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,189,70,,151.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,337.5,
MM 3D SCREENING LEFT,22810005,CDM,403,RC,77063,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MM 3D SCREENING BILAT,22810006,CDM,403,RC,77063,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MM 3D DIAG BILATERAL,22810007,CDM,401,RC,77062,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MM DIAG BILATERAL W/3D,22810008,CDM,401,RC,77066,HCPCS,OUTPATIENT,,,431.00,172.40,,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,135.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,135.88,366.35,
MM DIAG LEFT W/3D,22810009,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,359.00,143.60,,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215.4,60,,172.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,251.3,70,,201.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,106.63,305.15,
MM SCREENING BILAT W/3D,22810010,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,431.00,172.40,,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.4,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,112.31,366.35,
MM SCREENING RIGHT W/3D,22810011,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,431.00,172.40,,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.4,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,112.31,366.35,
MM SCREENING LEFT W/3D,22810012,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,431.00,172.40,,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.4,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,112.31,366.35,
MM DIAG RIGHT W/3D,22810013,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,359.00,143.60,,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215.4,60,,172.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,251.3,70,,201.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,114.88,32,,91.9,percent of total billed charges,32% of total billed charges,106.63,305.15,
MM LT SCREENING UNILAT DIGITAL,22810028,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,431.00,172.40,52,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.4,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,258.6,60,,206.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,301.7,70,,241.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,137.92,32,,110.34,percent of total billed charges,32% of total billed charges,112.31,366.35,
MM LT DIAG UNILATERAL DIGITAL,22810035,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,287.00,114.80,LT,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.2,60,,137.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,200.9,70,,160.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,243.95,
SINUSES 1V WATERS ONLY,22810036,CDM,320,RC,70210,HCPCS,OUTPATIENT,,,132.00,52.80,,23.52,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,23.52,112.2,
SKULL LIMIT,22810044,CDM,320,RC,70250,HCPCS,OUTPATIENT,,,132.00,52.80,,27.98,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,56.49,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,27.98,112.2,
SCOLIOSIS AP 2-3V,22810051,CDM,320,RC,72082,HCPCS,OUTPATIENT,,,291.00,116.40,,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,66.8,272,,,fee schedule,272% of BCBS fee schedule,66.8,272,,,fee schedule,272% of BCBS fee schedule,66.8,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,174.6,60,,139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,203.7,70,,162.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,66.8,247.35,
MANDIBLE 3 VIEWS,22810821,CDM,320,RC,70100,HCPCS,OUTPATIENT,,,137.00,54.80,,26.09,80,,,fee schedule,80% of Aetna fee schedule,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,26.09,116.45,
ARTHROGRAM PROCEDURE SHOULDER LT,22811001,CDM,322,RC,73040,HCPCS,OUTPATIENT,,,596.00,238.40,,79.41,80,,,fee schedule,80% of Aetna fee schedule,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,357.6,60,,286.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,129.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,506.6,85,,405.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,417.2,70,,333.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,190.72,32,,152.58,percent of total billed charges,32% of total billed charges,79.41,506.6,
MANDIBLE LT 3 VIEWS,22811821,CDM,320,RC,70100,HCPCS,OUTPATIENT,,,132.00,52.80,,26.09,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,47.36,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,26.09,112.2,
TMJ'S UNILAT LT OPEN & CLOSED MOUTH,22811888,CDM,320,RC,70328,HCPCS,OUTPATIENT,,,174.00,69.60,,23.28,80,,,fee schedule,80% of Aetna fee schedule,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,44.77,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.89,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,23.28,147.9,
PLEURAL DRAIN (CHEST TUBE INS) W/ IMAGIN,22832557,CDM,361,RC,32557,HCPCS,OUTPATIENT,,,3620.00,1448.00,,3000,100,,,case rate,pays based on per visit rate,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2172,60,,1737.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,846.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,3077,85,,2461.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,2534,70,,2027.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,1158.4,32,,926.72,percent of total billed charges,32% of total billed charges,846.71,3077,
ABD PARACENTESIS W/IMAGE GUID,22849083,CDM,361,RC,49083,HCPCS,OUTPATIENT,,,1744.00,697.60,,3000,100,,,case rate,pays based on per visit rate,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,419,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1046.4,60,,837.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,373.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,1220.8,70,,976.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,558.08,32,,446.46,percent of total billed charges,32% of total billed charges,373.7,3000,
US CATHERIZATION & INTROD SOHOHYST,22858340,CDM,320,RC,58340,HCPCS,OUTPATIENT,,,180.00,72.00,,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108,60,,86.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,225,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,126,70,,100.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,32,,46.08,percent of total billed charges,32% of total billed charges,57.6,225,
RIBS BILATERIAL  3 views,22871110,CDM,320,RC,71110,HCPCS,OUTPATIENT,,,132.00,52.80,,30.58,80,,,fee schedule,80% of Aetna fee schedule,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,71.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,30.58,112.2,
HIP RT 4V W/AP PELVIS,22873503,CDM,320,RC,73503,HCPCS,OUTPATIENT,,,291.00,116.40,RT,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,54.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,174.6,60,,139.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,55.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,203.7,70,,162.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,93.12,32,,74.5,percent of total billed charges,32% of total billed charges,54.75,247.35,
HYSTEROSALPINGOGRAPHY RS&I,22874740,CDM,320,RC,74740,HCPCS,OUTPATIENT,,,559.00,223.60,,58.06,80,,,fee schedule,80% of Aetna fee schedule,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,335.4,60,,268.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,97.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,58.06,475.15,
CTA ABD AORTA W/IF RUNOFF,25000108,CDM,352,RC,75635,HCPCS,OUTPATIENT,,,813.00,325.20,,873.37,100,,,case rate,pays based on per visit rate,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,487.8,60,,390.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,286.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,691.05,85,,552.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,569.1,70,,455.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,873.37,
CT ORBITS W/WO CONTRAST,25070482,CDM,351,RC,70482,HCPCS,OUTPATIENT,,,970.00,388.00,,864.46,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,196.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,196.21,864.46,
CT FACE W/ W/O CONTRASTS,25070488,CDM,351,RC,70488,HCPCS,OUTPATIENT,,,970.00,388.00,,846.29,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,161.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,161.88,846.29,
CT SINSUS W/ W/O CONTRASTS,25070489,CDM,351,RC,70488,HCPCS,OUTPATIENT,,,970.00,388.00,,846.29,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,161.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,161.88,846.29,
CT ANGIOGRAPHY HEAD W/WO CONTRAST &PP,25070496,CDM,351,RC,70496,HCPCS,OUTPATIENT,,,1385.00,554.00,,845.3,100,,,case rate,pays based on per visit rate,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,831,60,,664.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,249.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,1177.25,85,,941.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,969.5,70,,775.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,443.2,32,,354.56,percent of total billed charges,32% of total billed charges,249.44,1177.25,
CT ANGIOGRAPHY NECK W/WO CONTRAST &PP,25070498,CDM,351,RC,70498,HCPCS,OUTPATIENT,,,1430.00,572.00,,845.3,100,,,case rate,pays based on per visit rate,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,858,60,,686.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,249.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,1215.5,85,,972.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,1001,70,,800.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,457.6,32,,366.08,percent of total billed charges,32% of total billed charges,249.04,1215.5,
CT ANGIOGRAPHY CHEST W/WO CONTRAST,25071275,CDM,352,RC,71275,HCPCS,OUTPATIENT,,,1025.00,410.00,,848.57,100,,,case rate,pays based on per visit rate,328,32,,262.4,percent of total billed charges,32% of total billed charges,328,32,,262.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,615,60,,492,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,328,32,,262.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,32,,262.4,percent of total billed charges,32% of total billed charges,871.25,85,,697,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,32,,262.4,percent of total billed charges,32% of total billed charges,328,32,,262.4,percent of total billed charges,32% of total billed charges,717.5,70,,574,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,328,32,,262.4,percent of total billed charges,32% of total billed charges,328,32,,262.4,percent of total billed charges,32% of total billed charges,252.69,871.25,
CT HIP  LT WO CONTRAST,25071700,CDM,352,RC,73700,HCPCS,OUTPATIENT,,,558.00,223.20,,756.38,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,105.81,756.38,
CT ANGIOGRAPHY  LT LOW EXT,25071706,CDM,359,RC,73706,HCPCS,OUTPATIENT,,,1040.00,416.00,,851.39,100,,,case rate,pays based on per visit rate,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624,60,,499.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,263.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,884,85,,707.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,728,70,,582.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,263.11,884,
CT C SP W/WO CONTRAST,25072127,CDM,352,RC,72127,HCPCS,OUTPATIENT,,,970.00,388.00,,833.14,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,178.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,178.34,833.14,
CT T SP W/WO CONTRAST,25072130,CDM,352,RC,72130,HCPCS,OUTPATIENT,,,970.00,388.00,,833.14,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,179.55,833.14,
CT L SP W/WO CONTRAST,25072133,CDM,352,RC,72133,HCPCS,OUTPATIENT,,,970.00,388.00,,832.89,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,177.93,832.89,
CT ANGIO PELVIS W/WO CONTRAST,25072191,CDM,352,RC,72191,HCPCS,OUTPATIENT,,,1080.00,432.00,,847.65,100,,,case rate,pays based on per visit rate,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648,60,,518.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259.17,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,918,85,,734.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,756,70,,604.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,345.6,32,,276.48,percent of total billed charges,32% of total billed charges,259.17,918,
CT ANGIOGRAPHY UP EXT RT,25073206,CDM,359,RC,73206,HCPCS,OUTPATIENT,,,984.00,393.60,,847.34,100,,,case rate,pays based on per visit rate,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,590.4,60,,472.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,836.4,85,,669.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,688.8,70,,551.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,259.02,847.34,
CT ANGIOGRAPHY UP EXT LT,25073266,CDM,359,RC,73206,HCPCS,OUTPATIENT,,,984.00,393.60,,847.34,100,,,case rate,pays based on per visit rate,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,590.4,60,,472.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259.02,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,836.4,85,,669.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,688.8,70,,551.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,314.88,32,,251.9,percent of total billed charges,32% of total billed charges,259.02,847.34,
CT HIP RT WO CONTRAST,25073700,CDM,352,RC,73700,HCPCS,OUTPATIENT,,,558.00,223.20,RT,756.38,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,105.81,756.38,
CT ANGIOGRAPHY RT LOW EXT,25073706,CDM,359,RC,73706,HCPCS,OUTPATIENT,,,1040.00,416.00,,851.39,100,,,case rate,pays based on per visit rate,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624,60,,499.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,263.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,884,85,,707.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,728,70,,582.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,332.8,32,,266.24,percent of total billed charges,32% of total billed charges,263.11,884,
CT APPENDIX,25074111,CDM,350,RC,72193,HCPCS,OUTPATIENT,,,875.00,350.00,,784.46,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,227.7,784.46,
CT KIDNEY W CONTRAST,25074160,CDM,352,RC,74160,HCPCS,OUTPATIENT,,,875.00,350.00,,811.96,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,228.49,811.96,
CT KIDNEY W/WO CONTRAST,25074170,CDM,352,RC,74170,HCPCS,OUTPATIENT,,,1020.00,408.00,,830.64,100,,,case rate,pays based on per visit rate,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,768.29,272,,,fee schedule,272% of BCBS fee schedule,768.29,272,,,fee schedule,272% of BCBS fee schedule,768.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,612,60,,489.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,867,85,,693.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,714,70,,571.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,240.26,867,
CTA  ABD/PELVIS W/WO,25074174,CDM,352,RC,74174,HCPCS,OUTPATIENT,,,1150.00,460.00,,600,100,,,case rate,pays based on per visit rate,368,32,,294.4,percent of total billed charges,32% of total billed charges,368,32,,294.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,690,60,,552,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,360.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,977.5,85,,782,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,368,32,,294.4,percent of total billed charges,32% of total billed charges,805,70,,644,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,368,32,,294.4,percent of total billed charges,32% of total billed charges,360.74,977.5,
CT ANGIOGRAPHY ABD W/WO CONTRAST,25074175,CDM,352,RC,74175,HCPCS,OUTPATIENT,,,1150.00,460.00,,848.27,100,,,case rate,pays based on per visit rate,368,32,,294.4,percent of total billed charges,32% of total billed charges,368,32,,294.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,690,60,,552,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,977.5,85,,782,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,368,32,,294.4,percent of total billed charges,32% of total billed charges,805,70,,644,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,368,32,,294.4,percent of total billed charges,32% of total billed charges,368,32,,294.4,percent of total billed charges,32% of total billed charges,259.84,977.5,
CT ABD/PELVIS WO CONTRAST,25074176,CDM,352,RC,74176,HCPCS,OUTPATIENT,,,1180.00,472.00,,766.94,100,,,case rate,pays based on per visit rate,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,708,60,,566.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1003,85,,802.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,826,70,,660.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,130.6,1050.3,
CT ABD PELVIS W CONTRAST,25074177,CDM,352,RC,74177,HCPCS,OUTPATIENT,,,1720.00,688.00,,859.98,100,,,case rate,pays based on per visit rate,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1032,60,,825.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,1204,70,,963.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,287.19,1462,
CT ABD/PELVIS W/WO CONTRAST,25074178,CDM,352,RC,74178,HCPCS,OUTPATIENT,,,1690.00,676.00,,928.46,100,,,case rate,pays based on per visit rate,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1536.58,272,,,fee schedule,272% of BCBS fee schedule,1536.58,272,,,fee schedule,272% of BCBS fee schedule,1536.58,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1014,60,,811.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,323.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1183,70,,946.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,323.75,1536.58,
CT LIMITED W/ANGIOGRAPHY F/UP,25076380,CDM,359,RC,76380,HCPCS,OUTPATIENT,,,388.00,155.20,,719.11,100,,,case rate,pays based on per visit rate,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,317.64,272,,,fee schedule,272% of BCBS fee schedule,317.64,272,,,fee schedule,272% of BCBS fee schedule,317.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,232.8,60,,186.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,111.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,271.6,70,,217.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,124.16,32,,99.33,percent of total billed charges,32% of total billed charges,111.91,719.11,
CT UNLISTED PROCEDURE,25076497,CDM,351,RC,76497,HCPCS,OUTPATIENT,,,310.00,124.00,,600,100,,,case rate,pays based on per visit rate,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186,60,,148.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,263.5,85,,210.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,217,70,,173.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,32,,79.36,percent of total billed charges,32% of total billed charges,99.2,600,
CT GUIDED NEEDLE PLACEMENT,25077012,CDM,350,RC,77012,HCPCS,OUTPATIENT,,,267.00,106.80,,696.26,100,,,case rate,pays based on per visit rate,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,747.86,272,,,fee schedule,272% of BCBS fee schedule,747.86,272,,,fee schedule,272% of BCBS fee schedule,747.86,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,160.2,60,,128.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,88.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,747.86,
CT PE STUDY,25077275,CDM,352,RC,71275,HCPCS,OUTPATIENT,,,1026.00,410.40,,848.57,100,,,case rate,pays based on per visit rate,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,615.6,60,,492.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,872.1,85,,697.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,718.2,70,,574.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,328.32,32,,262.66,percent of total billed charges,32% of total billed charges,252.69,872.1,
CT IAC ORBITS W/W/O CONTRAST,25078483,CDM,351,RC,70482,HCPCS,OUTPATIENT,,,970.00,388.00,,864.46,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,196.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,196.21,864.46,
CT C SP WO CONTRAST,25080058,CDM,352,RC,72125,HCPCS,OUTPATIENT,,,558.00,223.20,,756.88,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,106.63,756.88,
CT SHOULDER LT WO CONTRAST,25505055,CDM,352,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,LT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
CT APPENDIX,25800321,CDM,352,RC,74177,HCPCS,OUTPATIENT,,,1690.00,676.00,,859.98,100,,,case rate,pays based on per visit rate,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1014,60,,811.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1183,70,,946.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,287.19,1436.5,
CT STONE PROTOCOL,25800433,CDM,352,RC,74176,HCPCS,OUTPATIENT,,,1180.00,472.00,,766.94,100,,,case rate,pays based on per visit rate,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,708,60,,566.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1003,85,,802.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,826,70,,660.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,130.6,1050.3,
CT BIOPSY SYST 18GA CO,25804008,CDM,272,RC,,,OUTPATIENT,,,159.00,63.60,,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.4,60,,76.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,111.3,70,,89.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,135.15,
CT TRAY BIOPSY GEN,25804009,CDM,272,RC,,,OUTPATIENT,,,103.00,41.20,,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.8,60,,49.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,72.1,70,,57.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,32,,26.37,percent of total billed charges,32% of total billed charges,32.96,87.55,
CT UPR EXT RT  WO CONTRAST,25804010,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,RT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
"CT 3D REND, I&RCT/MR/US OR OTHER",25804011,CDM,359,RC,76376,HCPCS,OUTPATIENT,,,166.00,66.40,,643.22,100,,,case rate,pays based on per visit rate,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,320.25,272,,,fee schedule,272% of BCBS fee schedule,320.25,272,,,fee schedule,272% of BCBS fee schedule,320.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,16.45,643.22,
CT UPR EXT RT W/WO CONT,25804015,CDM,350,RC,73202,HCPCS,OUTPATIENT,,,970.00,388.00,RT,822.69,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,231.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,231.26,824.5,
CT LWR EXT RT WO CONT,25804020,CDM,352,RC,73700,HCPCS,OUTPATIENT,,,558.00,223.20,RT,756.38,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,105.81,756.38,
CT BONE DENSITY,25804021,CDM,352,RC,77078,HCPCS,OUTPATIENT,,,222.00,88.80,,687.3,100,,,case rate,pays based on per visit rate,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,267.68,272,,,fee schedule,272% of BCBS fee schedule,267.68,272,,,fee schedule,272% of BCBS fee schedule,267.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,133.2,60,,106.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,155.4,70,,124.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,687.3,
CT LWR EXT RT W/WO CONT,25804025,CDM,352,RC,73702,HCPCS,OUTPATIENT,,,970.00,388.00,RT,844.54,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,177.53,844.54,
CT BONE DENSITY-MCARE,25804027,CDM,352,RC,77078,HCPCS,OUTPATIENT,,,222.00,88.80,,687.3,100,,,case rate,pays based on per visit rate,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,267.68,272,,,fee schedule,272% of BCBS fee schedule,267.68,272,,,fee schedule,272% of BCBS fee schedule,267.68,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,133.2,60,,106.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,155.4,70,,124.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,32,,56.83,percent of total billed charges,32% of total billed charges,71.04,687.3,
LDCT,25804029,CDM,352,RC,71271,HCPCS,OUTPATIENT,,,528.00,211.20,,600,100,,,case rate,pays based on per visit rate,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316.8,60,,253.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,111.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,448.8,85,,359.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,369.6,70,,295.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,168.96,32,,135.17,percent of total billed charges,32% of total billed charges,111.1,600,
CT CHEST W/WO CONTRAST,25804030,CDM,352,RC,71270,HCPCS,OUTPATIENT,,,970.00,388.00,,836.9,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,178.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,178.34,836.9,
CT C SP W/CONTRAST,25804035,CDM,352,RC,72126,HCPCS,OUTPATIENT,,,875.00,350.00,,795.03,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,143.59,795.03,
CT PITUITARY,25804040,CDM,351,RC,70481,HCPCS,OUTPATIENT,,,875.00,350.00,,838.82,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,164.31,838.82,
CT FACIAL BONES W/CONT,25804045,CDM,351,RC,70487,HCPCS,OUTPATIENT,,,875.00,350.00,,804.35,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,127.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,127.75,804.35,
CT FACIAL WO CONTRAST,25804050,CDM,351,RC,70486,HCPCS,OUTPATIENT,,,570.00,228.00,,770.64,100,,,case rate,pays based on per visit rate,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,342,60,,273.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,399,70,,319.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,112.31,770.64,
CT HEAD W/WO CONTRAST,25804055,CDM,351,RC,70470,HCPCS,OUTPATIENT,,,975.00,390.00,,794.6,100,,,case rate,pays based on per visit rate,312,32,,249.6,percent of total billed charges,32% of total billed charges,312,32,,249.6,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,585,60,,468,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,146.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,312,32,,249.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,32,,249.6,percent of total billed charges,32% of total billed charges,828.75,85,,663,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,32,,249.6,percent of total billed charges,32% of total billed charges,312,32,,249.6,percent of total billed charges,32% of total billed charges,682.5,70,,546,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,312,32,,249.6,percent of total billed charges,32% of total billed charges,312,32,,249.6,percent of total billed charges,32% of total billed charges,146.84,828.75,
CT NECK W/WO CONTRAST,25804060,CDM,351,RC,70492,HCPCS,OUTPATIENT,,,970.00,388.00,,838.42,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,188.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,188.9,838.42,
CT ABD W/WO,25804065,CDM,352,RC,74170,HCPCS,OUTPATIENT,,,1020.00,408.00,,830.64,100,,,case rate,pays based on per visit rate,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,768.29,272,,,fee schedule,272% of BCBS fee schedule,768.29,272,,,fee schedule,272% of BCBS fee schedule,768.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,612,60,,489.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,867,85,,693.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,714,70,,571.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,326.4,32,,261.12,percent of total billed charges,32% of total billed charges,240.26,867,
CT PELVIS W/WO CONT,25804070,CDM,352,RC,72194,HCPCS,OUTPATIENT,,,970.00,388.00,,822.69,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,768.29,272,,,fee schedule,272% of BCBS fee schedule,768.29,272,,,fee schedule,272% of BCBS fee schedule,768.29,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,231.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,231.26,824.5,
CT SINUSES LTD,25804080,CDM,351,RC,76380,HCPCS,OUTPATIENT,,,562.00,224.80,,719.11,100,,,case rate,pays based on per visit rate,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,317.64,272,,,fee schedule,272% of BCBS fee schedule,317.64,272,,,fee schedule,272% of BCBS fee schedule,317.64,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,337.2,60,,269.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,111.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,477.7,85,,382.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,393.4,70,,314.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,179.84,32,,143.87,percent of total billed charges,32% of total billed charges,111.91,719.11,
CT UPR EXT  LT W/WO CONT,25804115,CDM,350,RC,73202,HCPCS,OUTPATIENT,,,970.00,388.00,LT,822.69,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,231.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,231.26,824.5,
CT UPR EXT  LT WO CONTRAST,25804410,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,LT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
CT ABD W/CONTRAST,25805004,CDM,352,RC,74160,HCPCS,OUTPATIENT,,,875.00,350.00,,811.96,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,228.49,811.96,
CT ABD WO CONTRAST,25805006,CDM,352,RC,74150,HCPCS,OUTPATIENT,,,558.00,223.20,,755.67,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,104.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,104.19,755.67,
*CT C SP WO CONTRAST  (NO LONGER USED),25805008,CDM,352,RC,72125,HCPCS,OUTPATIENT,,,592.00,236.80,,756.88,100,,,case rate,pays based on per visit rate,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,355.2,60,,284.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,414.4,70,,331.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,106.63,756.88,
CT CHEST W/CONTRAST,25805010,CDM,352,RC,71260,HCPCS,OUTPATIENT,,,905.00,362.00,,795.32,100,,,case rate,pays based on per visit rate,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,543,60,,434.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,769.25,85,,615.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,633.5,70,,506.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,289.6,32,,231.68,percent of total billed charges,32% of total billed charges,144,795.32,
CT KNEE RT W/CONTRAST,25805011,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,LT,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT CHEST WO CONTRAST,25805012,CDM,352,RC,71250,HCPCS,OUTPATIENT,,,592.00,236.80,,755.6,100,,,case rate,pays based on per visit rate,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,355.2,60,,284.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,503.2,85,,402.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,414.4,70,,331.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,189.44,32,,151.55,percent of total billed charges,32% of total billed charges,105.41,755.6,
CT LEG RT W/CONTRAST,25805013,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,RT,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT HEAD W/CONTRAST,25805014,CDM,351,RC,70460,HCPCS,OUTPATIENT,,,875.00,350.00,,761.69,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,122.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,122.48,761.69,
CT HEAD WO CONTRAST,25805018,CDM,351,RC,70450,HCPCS,OUTPATIENT,,,558.00,223.20,,723.06,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,84.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,84.7,723.06,
CT PELVIS W/CONTRAST,25805022,CDM,352,RC,72193,HCPCS,OUTPATIENT,,,875.00,350.00,,784.46,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,227.7,784.46,
CT PELVIS WO CONT,25805024,CDM,352,RC,72192,HCPCS,OUTPATIENT,,,591.00,236.40,,751.66,100,,,case rate,pays based on per visit rate,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,354.6,60,,283.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,502.35,85,,401.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,413.7,70,,330.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,105.41,751.66,
CT SINUSES W/CONTRAST,25805025,CDM,351,RC,70487,HCPCS,OUTPATIENT,,,875.00,350.00,,804.35,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,127.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,127.75,804.35,
CT SINUSES WO CONTRAST,25805026,CDM,351,RC,70486,HCPCS,OUTPATIENT,,,570.00,228.00,,770.64,100,,,case rate,pays based on per visit rate,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,342,60,,273.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,484.5,85,,387.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,399,70,,319.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,182.4,32,,145.92,percent of total billed charges,32% of total billed charges,112.31,770.64,
**CT UPR EXT WO CONTRAST,25805028,CDM,352,RC,73200,HCPCS,OUTPATIENT,,,1177.00,470.80,,746.82,100,,,case rate,pays based on per visit rate,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,706.2,60,,564.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,1000.45,85,,800.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,823.9,70,,659.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,149.28,1000.45,
CT L SP WO CONTRAST,25805030,CDM,352,RC,72131,HCPCS,OUTPATIENT,,,591.00,236.40,,756.37,100,,,case rate,pays based on per visit rate,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,354.6,60,,283.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,502.35,85,,401.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,413.7,70,,330.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,105.81,756.37,
CT L SP W/CONTRAST,25805032,CDM,352,RC,72132,HCPCS,OUTPATIENT,,,875.00,350.00,,795.03,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,143.59,795.03,
CT LWR EXT RT W/CONTRAST,25805034,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,RT,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT NECK WO CONTRAST,25805036,CDM,351,RC,70490,HCPCS,OUTPATIENT,,,558.00,223.20,,766.29,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,115.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,115.98,766.29,
CT NECK W/CONTRAST,25805038,CDM,351,RC,70491,HCPCS,OUTPATIENT,,,875.00,350.00,,800.14,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,154.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,154.56,800.14,
CT UPR EXT RT W/CONTRAST,25805040,CDM,350,RC,73201,HCPCS,OUTPATIENT,,,875.00,350.00,RT,791.62,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,189.9,791.62,
CT ORBITS sella/post fossa ear WO CON,25805042,CDM,351,RC,70480,HCPCS,OUTPATIENT,,,558.00,223.20,,807.13,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,126.54,807.13,
CT IAC ORBITS W/O CONTRAST,25805043,CDM,351,RC,70480,HCPCS,OUTPATIENT,,,558.00,223.20,,807.13,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,126.54,807.13,
CT ORBITS sella/post fossa W/CONTRAST,25805044,CDM,351,RC,70481,HCPCS,OUTPATIENT,,,875.00,350.00,,838.82,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,164.31,838.82,
CT MAXILLO FACIAL WO CONTRAST,25805045,CDM,351,RC,70486,HCPCS,OUTPATIENT,,,473.00,189.20,,770.64,100,,,case rate,pays based on per visit rate,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,283.8,60,,227.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,112.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,402.05,85,,321.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,331.1,70,,264.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,151.36,32,,121.09,percent of total billed charges,32% of total billed charges,112.31,770.64,
CT THORACIC SP WO CONT,25805046,CDM,352,RC,72128,HCPCS,OUTPATIENT,,,591.00,236.40,,756.62,100,,,case rate,pays based on per visit rate,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,354.6,60,,283.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,106.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,502.35,85,,401.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,413.7,70,,330.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,106.23,756.62,
CT IAC W/CONTRAST,25805047,CDM,351,RC,70481,HCPCS,OUTPATIENT,,,875.00,350.00,,838.82,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,164.31,838.82,
CT THORACIC SP W/CONTRAST,25805048,CDM,352,RC,72129,HCPCS,OUTPATIENT,,,875.00,350.00,,795.8,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.81,795.8,
CT SHOULDER RT WO CONTRAST,25805050,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,RT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
CT KIDNEY WO CONTRAST,25805055,CDM,352,RC,74150,HCPCS,OUTPATIENT,,,558.00,223.20,,755.67,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,514.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,104.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,104.19,755.67,
CT ANKLE RT W/CONTRAST,25805056,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT LIVER W/CONTRAST,25805057,CDM,352,RC,74160,HCPCS,OUTPATIENT,,,875.00,350.00,,811.96,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,620.11,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,228.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,228.49,811.96,
CT SACRUM WO CONTRAST,25805060,CDM,352,RC,72131,HCPCS,OUTPATIENT,,,591.00,236.40,,756.37,100,,,case rate,pays based on per visit rate,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,354.6,60,,283.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,502.35,85,,401.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,413.7,70,,330.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,189.12,32,,151.3,percent of total billed charges,32% of total billed charges,105.81,756.37,
CT WRIST RT W CONTRAST,25805065,CDM,350,RC,73201,HCPCS,OUTPATIENT,,,875.00,350.00,RT,791.62,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,189.9,791.62,
CT WRIST LT W CONTRAST,25805066,CDM,350,RC,73201,HCPCS,OUTPATIENT,,,875.00,350.00,LT,791.62,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,189.9,791.62,
CT CHEST/ABD/PELVIS W/CONTRAST PANEL,25805067,CDM,350,RC,74177,HCPCS,OUTPATIENT,,,1720.00,688.00,,859.98,100,,,case rate,pays based on per visit rate,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1032,60,,825.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,1462,85,,1169.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,1204,70,,963.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,550.4,32,,440.32,percent of total billed charges,32% of total billed charges,287.19,1462,
CT ABD/PELVIS W/CONTRAST,25805068,CDM,350,RC,74177,HCPCS,OUTPATIENT,,,1000.00,400.00,,859.98,100,,,case rate,pays based on per visit rate,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,1240.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,600,60,,480,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,850,85,,680,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,700,70,,560,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,320,32,,256,percent of total billed charges,32% of total billed charges,320,32,,256,percent of total billed charges,32% of total billed charges,287.19,1240.21,
CT THORAX W/CONTRAST,25805069,CDM,350,RC,71260,HCPCS,OUTPATIENT,,,690.00,276.00,,795.32,100,,,case rate,pays based on per visit rate,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,414,60,,331.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,586.5,85,,469.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,483,70,,386.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,220.8,32,,176.64,percent of total billed charges,32% of total billed charges,144,795.32,
CT WRIST RT  WO CONTRAST,25805070,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,RT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
CT CHEST/ABD/PELVIS W/O CONTRAST PANEL,25805071,CDM,350,RC,74176,HCPCS,OUTPATIENT,,,1180.00,472.00,,766.94,100,,,case rate,pays based on per visit rate,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,1050.3,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,708,60,,566.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,1003,85,,802.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,826,70,,660.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,377.6,32,,302.08,percent of total billed charges,32% of total billed charges,130.6,1050.3,
CT WRIST LT WO CONTRAST,25805077,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,LT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
CT UPR EXT LT  W/CONTRAST,25805540,CDM,350,RC,73201,HCPCS,OUTPATIENT,,,875.00,350.00,LT,791.62,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,189.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,189.9,791.62,
CT BIOPSY PERCUTANEOUS,25806065,CDM,352,RC,77012,HCPCS,OUTPATIENT,,,825.00,330.00,,696.26,100,,,case rate,pays based on per visit rate,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,747.86,272,,,fee schedule,272% of BCBS fee schedule,747.86,272,,,fee schedule,272% of BCBS fee schedule,747.86,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,495,60,,396,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,88.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,701.25,85,,561,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,577.5,70,,462,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,264,32,,211.2,percent of total billed charges,32% of total billed charges,264,32,,211.2,percent of total billed charges,32% of total billed charges,88.76,747.86,
CT L SP W/WO CONTRAST,25808032,CDM,352,RC,72133,HCPCS,OUTPATIENT,,,1480.00,592.00,,832.89,100,,,case rate,pays based on per visit rate,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,800.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,888,60,,710.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,1258,85,,1006.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,1036,70,,828.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,473.6,32,,378.88,percent of total billed charges,32% of total billed charges,177.93,1258,
CT LWR EXT LT  WO CONT,25814020,CDM,352,RC,73700,HCPCS,OUTPATIENT,,,558.00,223.20,LT,756.38,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,105.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,105.81,756.38,
CT LWR EXT LT W/WO CONT,25814025,CDM,352,RC,73702,HCPCS,OUTPATIENT,,,970.00,388.00,LT,844.54,100,,,case rate,pays based on per visit rate,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,673.99,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,582,60,,465.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,679,70,,543.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,310.4,32,,248.32,percent of total billed charges,32% of total billed charges,177.53,844.54,
CT KNEE LT W/CONTRAST,25815011,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,LT,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT LEG  LT W/CONTRAST,25815013,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,LT,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT LWR EXT  LT W/CONTRAST,25815034,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,LT,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT ANKLE LT W/CONTRAST,25815056,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,875.00,350.00,,793.66,100,,,case rate,pays based on per visit rate,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,536.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,525,60,,420,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,743.75,85,,595,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,612.5,70,,490,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,280,32,,224,percent of total billed charges,32% of total billed charges,280,32,,224,percent of total billed charges,32% of total billed charges,144.4,793.66,
CT SHOULDER LT WO CONTRAST,25815057,CDM,352,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,LT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
CT HEMATURIAGRAM,25815058,CDM,352,RC,74178,HCPCS,OUTPATIENT,,,1690.00,676.00,,928.46,100,,,case rate,pays based on per visit rate,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1536.58,272,,,fee schedule,272% of BCBS fee schedule,1536.58,272,,,fee schedule,272% of BCBS fee schedule,1536.58,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1014,60,,811.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,323.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1436.5,85,,1149.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,1183,70,,946.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,540.8,32,,432.64,percent of total billed charges,32% of total billed charges,323.75,1536.58,
CT CALCIUM SCORE,25815059,CDM,350,RC,75571,HCPCS,OUTPATIENT,,,250.00,100.00,,681.62,100,,,case rate,pays based on per visit rate,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,60,,120,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,91.2,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,175,70,,140,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80,32,,64,percent of total billed charges,32% of total billed charges,80,32,,64,percent of total billed charges,32% of total billed charges,80,681.62,
CT HEART W/C W/3D IMAGE,25815060,CDM,350,RC,75572,HCPCS,OUTPATIENT,,,438.00,175.20,,823.97,100,,,case rate,pays based on per visit rate,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.8,60,,210.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,187.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,823.97,
CCTA W/3D CONGENITAL,25815061,CDM,350,RC,75573,HCPCS,OUTPATIENT,,,438.00,175.20,,880.67,100,,,case rate,pays based on per visit rate,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.8,60,,210.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,239.69,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,306.6,70,,245.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,32,,112.13,percent of total billed charges,32% of total billed charges,140.16,880.67,
CCTA W/3D,25815062,CDM,350,RC,75574,HCPCS,OUTPATIENT,,,627.00,250.80,,873.66,100,,,case rate,pays based on per visit rate,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.2,60,,300.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,273.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,532.95,85,,426.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,438.9,70,,351.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,200.64,32,,160.51,percent of total billed charges,32% of total billed charges,200.64,873.66,
CCTA DATA AND TRANSMISSION,25815063,CDM,480,RC,0624T,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
CCTA  ANALYSIS,25815064,CDM,480,RC,0625T,HCPCS,OUTPATIENT,,,4500.00,1800.00,,,,,,other ,not seperately reimbursable,1440,32,,1152,percent of total billed charges,32% of total billed charges,1440,32,,1152,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2700,60,,2160,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1440,32,,1152,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1440,32,,1152,percent of total billed charges,32% of total billed charges,3825,85,,3060,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1440,32,,1152,percent of total billed charges,32% of total billed charges,1440,32,,1152,percent of total billed charges,32% of total billed charges,3150,70,,2520,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1440,32,,1152,percent of total billed charges,32% of total billed charges,1440,32,,1152,percent of total billed charges,32% of total billed charges,1440,3825,
3D RECON,25815065,CDM,350,RC,76377,HCPCS,OUTPATIENT,,,108.00,43.20,,659.66,100,,,case rate,pays based on per visit rate,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,320.25,272,,,fee schedule,272% of BCBS fee schedule,320.25,272,,,fee schedule,272% of BCBS fee schedule,320.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,64.8,60,,51.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,75.6,70,,60.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,659.66,
MAGNEVIST 20ML DOSE,26012398,CDM,255,RC,A9579,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
GADOBUTROL 10ML DOSE,26012399,CDM,255,RC,A9585,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
MRI TMJ,26070336,CDM,611,RC,70336,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,257.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,257.95,1015.54,
MRI ORBIT/FACE/NECK WO CONTRAST,26070540,CDM,614,RC,70540,HCPCS,OUTPATIENT,,,1160.00,464.00,,750,100,,,case rate,pays based on per visit rate,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,696,60,,556.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,213.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,986,85,,788.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,812,70,,649.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,213.26,1015.54,
MRA HEAD/NECK W/CONT,26070541,CDM,615,RC,70542,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,252.26,1015.54,
MRI IAC  WO CONTRAST,26070542,CDM,614,RC,70540,HCPCS,OUTPATIENT,,,1160.00,464.00,,750,100,,,case rate,pays based on per visit rate,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,696,60,,556.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,213.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,986,85,,788.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,812,70,,649.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,213.26,1015.54,
MRI SACROILIAC JOINTS,26070543,CDM,610,RC,72195,HCPCS,OUTPATIENT,,,1195.00,478.00,,750,100,,,case rate,pays based on per visit rate,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,717,60,,573.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,211.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.75,85,,812.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,836.5,70,,669.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,211.24,1015.75,
MRI IAC W/ WO CONTRASTS,26070544,CDM,611,RC,70553,HCPCS,OUTPATIENT,,,2488.00,995.20,,750,100,,,case rate,pays based on per visit rate,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1492.8,60,,1194.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,276.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2114.8,85,,1691.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,1741.6,70,,1393.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,276.65,2255.72,
MRA HEAD W/O CONTRAST,26070545,CDM,615,RC,70544,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,205.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,205.55,1015.54,
MRI TEMPORAL W/CONTRASTS,26070546,CDM,611,RC,70542,HCPCS,OUTPATIENT,,,1288.00,515.20,,750,100,,,case rate,pays based on per visit rate,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,772.8,60,,618.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,1094.8,85,,875.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,901.6,70,,721.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,252.26,1094.8,
MRI TEMPORAL  WO CONTRAST,26070547,CDM,614,RC,70540,HCPCS,OUTPATIENT,,,1160.00,464.00,,750,100,,,case rate,pays based on per visit rate,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,696,60,,556.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,213.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,986,85,,788.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,812,70,,649.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,213.26,1015.54,
MRI SACRUM W/O CONTRAST,26070548,CDM,610,RC,72195,HCPCS,OUTPATIENT,,,1195.00,478.00,,750,100,,,case rate,pays based on per visit rate,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,717,60,,573.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,211.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.75,85,,812.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,836.5,70,,669.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,211.24,1015.75,
MRI SACRUM W CONTRAST,26070549,CDM,610,RC,72196,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,246.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,246.58,1113.5,
MRI RECONSTRUCTION,26070550,CDM,612,RC,,,OUTPATIENT,,,294.00,117.60,,750,100,,,case rate,pays based on per visit rate,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.4,60,,141.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,205.8,70,,164.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,750,
MRI BRAIN WO CONTRAST,26070551,CDM,611,RC,70551,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,164.53,1020,
MRI BRAIN W/CONTRAST,26070552,CDM,611,RC,70552,HCPCS,OUTPATIENT,,,1344.00,537.60,,750,100,,,case rate,pays based on per visit rate,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,806.4,60,,645.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,242.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,940.8,70,,752.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,242.91,1218.91,
MRI BRAIN W/WO CONTRAST,26070553,CDM,611,RC,70553,HCPCS,OUTPATIENT,,,2488.00,995.20,,750,100,,,case rate,pays based on per visit rate,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1492.8,60,,1194.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,276.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2114.8,85,,1691.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,1741.6,70,,1393.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,276.65,2255.72,
MRI COCCYX W/O CONTRACT,26070554,CDM,610,RC,72195,HCPCS,OUTPATIENT,,,1195.00,478.00,,750,100,,,case rate,pays based on per visit rate,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,717,60,,573.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,211.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.75,85,,812.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,836.5,70,,669.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,211.24,1015.75,
MRI COCCYX W CONTRAST,26070555,CDM,610,RC,72196,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,246.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,246.58,1113.5,
MRI ADRENALS W/O CONTRAST,26070556,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,166.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,166.34,1015.54,
MRI LIVER W/O CONTRAST,26070557,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,166.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,166.34,1015.54,
MRI LIVER W CONTRAST,26070558,CDM,610,RC,74182,HCPCS,OUTPATIENT,,,1455.00,582.00,,750,100,,,case rate,pays based on per visit rate,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,873,60,,698.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,290.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1236.75,85,,989.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1018.5,70,,814.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,290.04,1236.75,
MRI AXILLAE RT W & W/O CONTRAST,26070559,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI AXILLAE W/O CONTRAST,26070560,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI ABDOMEN W/O CONTRAST,26070561,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,166.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,166.34,1015.54,
MRI ABDOMEN W CONTRAST,26070562,CDM,610,RC,74182,HCPCS,OUTPATIENT,,,1455.00,582.00,,750,100,,,case rate,pays based on per visit rate,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,873,60,,698.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,290.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1236.75,85,,989.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1018.5,70,,814.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,290.04,1236.75,
MRI ABDOMEN W & W/O CONTRAST,26070563,CDM,610,RC,74183,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,310.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,310.38,2031.08,
MRI ANKLE RT W/O CONTRAST,26070564,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRI ANKLE RT W CONTRAST,26070565,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI ANKLE RT W  & W/O CONTRAST,26070566,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI BRACHIAL PLEXUS  RT W/O CONTRAST,26070567,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI BRACHIAL PLEXUS RT W & W/O CONTRAST,26070568,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI CHEST W/O CONTRAST,26070569,CDM,610,RC,71550,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,292.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,292.55,1015.54,
MRI CHEST W CONTRAST,26070570,CDM,610,RC,71551,HCPCS,OUTPATIENT,,,1615.00,646.00,,750,100,,,case rate,pays based on per visit rate,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,969,60,,775.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,385.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,1372.75,85,,1098.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,385.93,1372.75,
MRI CHEST W & W/O CONTRAST,26070571,CDM,610,RC,71552,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,463.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,463.41,2031.08,
MRI CLAVICLE RT W/O CONTRAST,26070572,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI CLAVICLE RT W & W/O CONTRAST,26070573,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI CSF FLOW STDY OF THE BRAIN,26070574,CDM,610,RC,70551,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.53,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,164.53,1015.54,
MRI ELBOW RT W/O CONTRAST,26070575,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRI ELBOW RT W CONTRAST,26070576,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI ELBOW RT W/WO CONTRAST,26070577,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI FEMUR RT W/O CONTRAST,26070578,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI FEMUR RT W CONTRAST,26070579,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI FEMUR RT W  & W/O CONTRAST,26070580,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI FOOT RT W/O CONTRAST,26070581,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI FOOT RT W CONTRAST,26070582,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI FOOT RT W & W/O CONTRAST,26070583,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI FOREARM RT W/O CONTRAST,26070584,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI FOREARM RT W CONTRAST,26070585,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,334.31,1113.5,
MRI HAND RT WO CONTRAST,26070586,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI HAND RT W CONTRAST,26070587,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,334.31,1113.5,
MRI HAND RT W  & W/O CONTRAST,26070588,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI FINGER RT W/O CONTRAST,26070589,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI HEEL RT W & W/O CONTRAST,26070590,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI HIP RT W/O CONTRAST,26070591,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRI HIP  RT W CONTRAST,26070592,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI HIP  RT W & W/O CONTRAST,26070593,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI HUMERUS RT W/O CONTRAST,26070594,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI HUMERUS RT W CONTRAST,26070595,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,334.31,1113.5,
MRI HUMERUS  RT W/WO CONTRAST,26070596,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI KIDNEYS  W CONTRAST,26070597,CDM,610,RC,74182,HCPCS,OUTPATIENT,,,1455.00,582.00,,750,100,,,case rate,pays based on per visit rate,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,873,60,,698.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,290.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1236.75,85,,989.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,1018.5,70,,814.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,465.6,32,,372.48,percent of total billed charges,32% of total billed charges,290.04,1236.75,
MRI KNEE RT W/O CONTRAST,26070598,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRI KNEE RT W CONTRAST,26070599,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI KNEE RT W/WO CONTRAST,26070600,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI LIVER W & W/O CONTRAST,26070601,CDM,610,RC,74183,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,310.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,310.38,2031.08,
MRI LOWER LEG RT W/O CONTRAST,26070602,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI LOWER LEG RT W CONTRAST,26070603,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI LOWER LEG RT W  & W/O CONTRAST,26070604,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI MANDIBLE,26070605,CDM,610,RC,70540,HCPCS,OUTPATIENT,,,1160.00,464.00,,750,100,,,case rate,pays based on per visit rate,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,696,60,,556.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,213.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,986,85,,788.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,812,70,,649.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,213.26,1015.54,
MRI MANDIBLE W & W/O CONTRAST,26070606,CDM,610,RC,70543,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,313.21,2031.08,
MRI NECK W/O CONTRAST,26070607,CDM,610,RC,70540,HCPCS,OUTPATIENT,,,1160.00,464.00,,750,100,,,case rate,pays based on per visit rate,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,696,60,,556.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,213.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,986,85,,788.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,812,70,,649.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,371.2,32,,296.96,percent of total billed charges,32% of total billed charges,213.26,1015.54,
MRI NECK W & W/O CONTRAST,26070608,CDM,610,RC,70543,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,313.21,2031.08,
MRI NO CHARGE,26070609,CDM,610,RC,,,OUTPATIENT,,,,,,750,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,750,750,
MRI ORBIT/FACE W/O CONTRAST,26070610,CDM,610,RC,70540,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,213.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,213.26,1015.54,
MRI ORBIT/FACE W CONTRAST,26070611,CDM,610,RC,70542,HCPCS,OUTPATIENT,,,1288.00,515.20,,750,100,,,case rate,pays based on per visit rate,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,772.8,60,,618.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,252.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,1094.8,85,,875.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,901.6,70,,721.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,412.16,32,,329.73,percent of total billed charges,32% of total billed charges,252.26,1094.8,
MRI ORBIT/FACE W & W/O CONTRAST,26070612,CDM,610,RC,70543,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,313.21,2031.08,
MRI PANCREAS W & W/O CONTRAST,26070613,CDM,610,RC,74183,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,310.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,310.38,2031.08,
MRI PELVIS(MSK/NEURO) W/O CONTRAST,26070614,CDM,610,RC,72195,HCPCS,OUTPATIENT,,,1195.00,478.00,,750,100,,,case rate,pays based on per visit rate,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,717,60,,573.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,211.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.75,85,,812.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,836.5,70,,669.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,211.24,1015.75,
MRI PELVIS(MSK/NEURO)W & W/O CONTRAST,26070615,CDM,610,RC,72197,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,309.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,309.15,2031.08,
MRI PITUITARY W & W/O CONTRAST,26070616,CDM,611,RC,70553,HCPCS,OUTPATIENT,,,2488.00,995.20,,750,100,,,case rate,pays based on per visit rate,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1492.8,60,,1194.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,276.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2114.8,85,,1691.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,1741.6,70,,1393.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,276.65,2255.72,
MRI SCAPULA  RT W/O CONTRAST,26070617,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI SHOULDER RT W/O CONTRAST,26070618,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRI SHOULDER RT W CONTRAST,26070619,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI SHOULDER RT W&W/O CONTRAST,26070620,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI THIGH RT W/O CONTRAST,26070621,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI THIGH RT W CONTRAST,26070622,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI THIGH RT W & W/O CONTRAST,26070623,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI THUMB RT W/O CONTRAST,26070624,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI WRIST W & W/O CONTRAST,26070625,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI WRIST ARTHROGRAM RT W CONTRAST,26070626,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI MRCP,26070627,CDM,614,RC,74183,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,310.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,310.38,2031.08,
MRI THUMB RT W & W/O CONTRAST,26070628,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI WRIST RT W/O CONTRAST,26070629,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRA PELVIS W/WO CONTRAST,26070630,CDM,618,RC,C8920,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA PELVIS W CONTRAST,26070631,CDM,618,RC,C8918,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA RENALS W CONTRAST,26070632,CDM,618,RC,C8900,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA RUNOFF W CONTRAST (ABD),26070633,CDM,618,RC,C8900,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA ABDOMEN W/WO CONTRAST,26070634,CDM,618,RC,C8902,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA ABDOMEN W CONTRAST,26070635,CDM,610,RC,74185,HCPCS,OUTPATIENT,,,1262.00,504.80,,750,100,,,case rate,pays based on per visit rate,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,757.2,60,,605.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,329.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,1072.7,85,,858.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,883.4,70,,706.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,403.84,32,,323.07,percent of total billed charges,32% of total billed charges,329.86,1072.7,
MRA AORTIC ARCH/GREAT VESSEL W/0 & W CON,26070636,CDM,618,RC,C8911,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA CHEST W CONTRAST,26070637,CDM,618,RC,C8909,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA CHEST W/O CONTRAST,26070638,CDM,618,RC,C8910,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA PELVIS W/O CONTRAST,26070639,CDM,610,RC,72198,HCPCS,OUTPATIENT,,,1264.00,505.60,,750,100,,,case rate,pays based on per visit rate,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,758.4,60,,606.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,329.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,1074.4,85,,859.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,884.8,70,,707.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,404.48,32,,323.58,percent of total billed charges,32% of total billed charges,329.05,1074.4,
MRA UPPER EXTERMITY W/O CONTRAST,26070640,CDM,610,RC,73225,HCPCS,OUTPATIENT,,,1277.00,510.80,,750,100,,,case rate,pays based on per visit rate,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,766.2,60,,612.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,340.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,1085.45,85,,868.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,893.9,70,,715.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,340.03,1085.45,
MRA UPPER EXTERMITY RT W & W/O CONTRAST,26070641,CDM,610,RC,C8936,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA SPINAL CANAL W & WO CONST,26070642,CDM,618,RC,C8933,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA LOW EXT RT W/WO CONTRAST,26070643,CDM,618,RC,C8913,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRA LOWER EXTERMITY W CONTRAST,26070644,CDM,610,RC,73725,HCPCS,OUTPATIENT,,,1213.00,485.20,,750,100,,,case rate,pays based on per visit rate,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,727.8,60,,582.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,327.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,1031.05,85,,824.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,849.1,70,,679.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,327.03,1099.94,
MRI LWR EXT LT WO/CONTRAST,26071410,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI JOINT LW WXT  LT W/CONT,26071412,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI JOINT LW EXT LT W/WO/C,26071413,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI CHEST WO CONTRAST,26071550,CDM,610,RC,71550,HCPCS,OUTPATIENT,,,1615.00,646.00,,750,100,,,case rate,pays based on per visit rate,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,969,60,,775.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,292.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,1372.75,85,,1098.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,516.8,32,,413.44,percent of total billed charges,32% of total billed charges,292.55,1372.75,
MRI CHEST W/ W/O CONTRAST,26071552,CDM,614,RC,71552,HCPCS,OUTPATIENT,,,3809.00,1523.60,,750,100,,,case rate,pays based on per visit rate,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,2285.4,60,,1828.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,463.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,3237.65,85,,2590.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,2666.3,70,,2133.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,1218.88,32,,975.1,percent of total billed charges,32% of total billed charges,463.41,3237.65,
MRA CHEST W/WO (EX MYOCARD0),26071555,CDM,614,RC,71555,HCPCS,OUTPATIENT,,,1260.00,504.00,,750,100,,,case rate,pays based on per visit rate,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,756,60,,604.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,326.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,1071,85,,856.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,882,70,,705.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,326.21,1071,
MRI ANKLE LT W/O CONTRAST,26071564,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRI ANKLE LT W CONTRAST,26071565,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI ANKLE  LT W  & W/O CONTRAST,26071566,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI FEMUR LT W/O CONTRAST,26071578,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI FEMUR LT W CONTRAST,26071579,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI FEMUR LT  W  & W/O CONTRAST,26071580,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI FOOT LT W/O CONTRAST,26071581,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI FOOT LT W CONTRAST,26071582,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI FOOT LT W & W/O CONTRAST,26071583,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI HEEL  LT W & W/O CONTRAST,26071590,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI HIP  LT W/O CONTRAST,26071591,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRI HIP LT  W CONTRAST,26071592,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI HIP LT W & W/O CONTRAST,26071593,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI KNEE LT W/O CONTRAST,26071598,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRI KNEE LT W CONTRAST,26071599,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI KNEE LT W/WO CONTRAST,26071600,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI LOWER LEG  LT W/O CONTRAST,26071602,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI LOWER LEG  LT W CONTRAST,26071603,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI LOWER LEG LT W  & W/O CONTRAST,26071604,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI THIGH LT W/O CONTRAST,26071621,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI THIGH LT W CONTRAST,26071622,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI THIGH LT W & W/O CONTRAST,26071623,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRA LOW EXT LT W/WO CONTRAST,26071643,CDM,618,RC,C8913,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
MRI JOINT LW EXT LT W/O C,26071721,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRI C SP WO CONTRAST,26072141,CDM,612,RC,72141,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,158.43,1015.54,
MRI C SP W/CONTRAST,26072142,CDM,612,RC,72142,HCPCS,OUTPATIENT,,,1326.00,530.40,,750,100,,,case rate,pays based on per visit rate,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,795.6,60,,636.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,250.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,1127.1,85,,901.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,928.2,70,,742.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,424.32,32,,339.46,percent of total billed charges,32% of total billed charges,250.64,1218.91,
MRI T SP WO CONT,26072146,CDM,612,RC,72146,HCPCS,OUTPATIENT,,,1243.00,497.20,,750,100,,,case rate,pays based on per visit rate,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,1127.22,272,,,fee schedule,272% of BCBS fee schedule,1127.22,272,,,fee schedule,272% of BCBS fee schedule,1127.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,745.8,60,,596.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,1056.55,85,,845.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,870.1,70,,696.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,158.43,1127.22,
MRI T SP W/CONTRAST,26072147,CDM,612,RC,72147,HCPCS,OUTPATIENT,,,1344.00,537.60,,750,100,,,case rate,pays based on per visit rate,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,806.4,60,,645.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,247.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,940.8,70,,752.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,247.39,1218.91,
MRI L SP WO CONTRAST,26072148,CDM,612,RC,72148,HCPCS,OUTPATIENT,,,1243.00,497.20,,750,100,,,case rate,pays based on per visit rate,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,1127.22,272,,,fee schedule,272% of BCBS fee schedule,1127.22,272,,,fee schedule,272% of BCBS fee schedule,1127.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,745.8,60,,596.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,1056.55,85,,845.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,870.1,70,,696.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,397.76,32,,318.21,percent of total billed charges,32% of total billed charges,158.84,1127.22,
MRI L SP W/CONTRAST,26072149,CDM,612,RC,72149,HCPCS,OUTPATIENT,,,1344.00,537.60,,750,100,,,case rate,pays based on per visit rate,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,1218.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,806.4,60,,645.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,1142.4,85,,913.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,940.8,70,,752.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,430.08,32,,344.06,percent of total billed charges,32% of total billed charges,244.54,1218.91,
MRI C SP W/WO CONTRAST,26072156,CDM,612,RC,72156,HCPCS,OUTPATIENT,,,2488.00,995.20,,750,100,,,case rate,pays based on per visit rate,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1492.8,60,,1194.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,278.66,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2114.8,85,,1691.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,1741.6,70,,1393.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,278.66,2255.72,
MRI T SP W/WO CONT,26072157,CDM,612,RC,72157,HCPCS,OUTPATIENT,,,2488.00,995.20,,750,100,,,case rate,pays based on per visit rate,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1492.8,60,,1194.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,279.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2114.8,85,,1691.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,1741.6,70,,1393.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,279.08,2255.72,
MRI L SP W/WO CONTRAST,26072158,CDM,612,RC,72158,HCPCS,OUTPATIENT,,,2488.00,995.20,,750,100,,,case rate,pays based on per visit rate,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,2255.72,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1492.8,60,,1194.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,277.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,2114.8,85,,1691.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,1741.6,70,,1393.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,796.16,32,,636.93,percent of total billed charges,32% of total billed charges,277.45,2255.72,
MRA SPINE CANAL W/W/O CON,26072159,CDM,618,RC,72159,HCPCS,OUTPATIENT,,,740.00,296.00,,750,100,,,case rate,pays based on per visit rate,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,444,60,,355.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,340.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,629,85,,503.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,518,70,,414.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,236.8,32,,189.44,percent of total billed charges,32% of total billed charges,236.8,750,
MRI PELVIS W CONTRAST,26072196,CDM,610,RC,72196,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,246.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,246.58,1113.5,
MRA PELVIS W/WO CONT,26072198,CDM,618,RC,72198,HCPCS,OUTPATIENT,,,713.00,285.20,,750,100,,,case rate,pays based on per visit rate,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.8,60,,342.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,329.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,228.16,750,
MRI UP EXT RT W/WO CONT,26073220,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI JOINT UP EXT RT W/O CONT,26073221,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRA UPR EXT WO CONT FOLLOWED W CONT,26073225,CDM,618,RC,73225,HCPCS,OUTPATIENT,,,1277.00,510.80,,750,100,,,case rate,pays based on per visit rate,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,766.2,60,,612.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,340.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,1085.45,85,,868.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,893.9,70,,715.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,408.64,32,,326.91,percent of total billed charges,32% of total billed charges,340.03,1085.45,
MRI LWR EXT LT W/WO CONTRAST,26073320,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI FOOT RT W/O CONTRAST,26073718,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI FOOT LT W/O CONTRAST,26073719,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI LWR EXT RT W/WO CONTRAST,26073720,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,311.99,2031.08,
MRI JOINT LW EXT RT W/O C,26073721,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,1158.00,463.20,,750,100,,,case rate,pays based on per visit rate,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,694.8,60,,555.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,984.3,85,,787.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,810.6,70,,648.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,370.56,32,,296.45,percent of total billed charges,32% of total billed charges,179.15,1015.54,
MRA LOW EXT W/ OR W/O CON,26073725,CDM,618,RC,73725,HCPCS,OUTPATIENT,,,712.00,284.80,,750,100,,,case rate,pays based on per visit rate,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,427.2,60,,341.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,327.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,605.2,85,,484.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,498.4,70,,398.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,227.84,32,,182.27,percent of total billed charges,32% of total billed charges,227.84,1099.94,
MRA LWR EXT ANGIO WO CONT,26073726,CDM,618,RC,73725,HCPCS,OUTPATIENT,,,1213.00,485.20,,750,100,,,case rate,pays based on per visit rate,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,727.8,60,,582.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,327.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,1031.05,85,,824.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,849.1,70,,679.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,327.03,1099.94,
MRA LWR EXT ANGIO WO CONT FOLLOW BY W,26073727,CDM,618,RC,73725,HCPCS,OUTPATIENT,,,1213.00,485.20,,750,100,,,case rate,pays based on per visit rate,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,1099.94,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,727.8,60,,582.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,327.03,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,1031.05,85,,824.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,849.1,70,,679.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,388.16,32,,310.53,percent of total billed charges,32% of total billed charges,327.03,1099.94,
MRI ABDOMEN,26074181,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,166.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,166.34,1015.54,
MRA ABDOMEN W/W/O CON,26074185,CDM,618,RC,74185,HCPCS,OUTPATIENT,,,716.00,286.40,,750,100,,,case rate,pays based on per visit rate,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,429.6,60,,343.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,329.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,608.6,85,,486.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,501.2,70,,400.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,32,,183.3,percent of total billed charges,32% of total billed charges,229.12,750,
MRI BREAST W/WO CONTR-UNIL,26076093,CDM,610,RC,77058,HCPCS,OUTPATIENT,,,1761.00,704.40,,750,100,,,case rate,pays based on per visit rate,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1056.6,60,,845.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,704.4,40,,563.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,1496.85,85,,1197.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,1232.7,70,,986.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,563.52,32,,450.82,percent of total billed charges,32% of total billed charges,563.52,1496.85,
MRI BONE MARROW BLOOD SUPPLY,26076400,CDM,610,RC,77084,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,299.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,299.18,1015.54,
MRA HEAD W/CONTRAST,26076401,CDM,615,RC,70545,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,220.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,220.99,1076.1,
MRA HEAD W/WO CONTRAST,26076402,CDM,615,RC,70546,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,335.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,335.55,2031.08,
MRA NECK WO/CONTRAST,26076403,CDM,615,RC,70547,HCPCS,OUTPATIENT,,,1330.00,532.00,,750,100,,,case rate,pays based on per visit rate,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,798,60,,638.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,206.36,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,1130.5,85,,904.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,931,70,,744.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,425.6,32,,340.48,percent of total billed charges,32% of total billed charges,206.36,1130.5,
MRA NECK W/CONTRAST,26076404,CDM,615,RC,70548,HCPCS,OUTPATIENT,,,1415.00,566.00,,750,100,,,case rate,pays based on per visit rate,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,849,60,,679.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,1202.75,85,,962.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,990.5,70,,792.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,452.8,32,,362.24,percent of total billed charges,32% of total billed charges,227.49,1202.75,
MRA NECK W/WO CONTRAST,26076405,CDM,615,RC,70549,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,337.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,337.59,2031.08,
MRI PELVIS W/O CONT,26076406,CDM,610,RC,72195,HCPCS,OUTPATIENT,,,1195.00,478.00,,750,100,,,case rate,pays based on per visit rate,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,717,60,,573.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,211.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,1015.75,85,,812.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,836.5,70,,669.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,382.4,32,,305.92,percent of total billed charges,32% of total billed charges,211.24,1015.75,
MRI PELVIS W/WO CONT,26076407,CDM,610,RC,72197,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,309.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,309.15,2031.08,
MRI UP EXT JOINT RT W/CONT,26076408,CDM,614,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI UP EXT JOINT RT W/WO CON,26076409,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI LWR EXT RT WO/CONTRAST,26076410,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,209.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,209.61,1020,
MRI LWR EXT RT W/CONTRAST,26076411,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI JOINT LW WXT RT W/CONT,26076412,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,312.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,312.38,1076.1,
MRI JOINT LW EXT  RT W/WO/C,26076413,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,377.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,377.8,2031.08,
MRI UP EXT RT WO/CONTRAST,26076414,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI UP EXT RT W/CONT,26076415,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1300.00,520.00,,750,100,,,case rate,pays based on per visit rate,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,780,60,,624,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,1105,85,,884,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,910,70,,728,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,334.31,1105,
MRI SCOUT,26076416,CDM,610,RC,,,OUTPATIENT,,,,,,750,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,750,750,
MRI UP EXT LT W/CONT,26076441,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1300.00,520.00,,750,100,,,case rate,pays based on per visit rate,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,780,60,,624,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,1105,85,,884,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,910,70,,728,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,416,32,,332.8,percent of total billed charges,32% of total billed charges,416,32,,332.8,percent of total billed charges,32% of total billed charges,334.31,1105,
MRI UNLISTED PROCEDURE,26076498,CDM,610,RC,76498,HCPCS,OUTPATIENT,,,985.00,394.00,,750,100,,,case rate,pays based on per visit rate,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,591,60,,472.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,837.25,85,,669.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,689.5,70,,551.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,32,,252.16,percent of total billed charges,32% of total billed charges,315.2,837.25,
MRI UP EXT LT W/WO CONT,26077220,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI JOINT UP EXT LT W/O CONT,26077321,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRI UP EXT JOINT  LT W/CONT,26077408,CDM,614,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI UP EXT JOINT LT W/WO CON,26077409,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI LWR EXT  LT W/CONTRAST,26077411,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,244.54,1113.5,
MRI UP EXT  LT WO/CONTRAST,26077414,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI AXILLAE LT W & W/O CONTRAST,26077559,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI BRACHIAL PLEXUS  LT W/O CONTRAST,26077567,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI BRACHIAL PLEXUS LT W & W/O CONTRAST,26077568,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI CLAVICLE LT W/O CONTRAST,26077572,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI CLAVICLE LT W & W/O CONTRAST,26077573,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI ELBOW LT W/O CONTRAST,26077575,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRI ELBOW LT W CONTRAST,26077576,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI ELBOW  LT W/WO CONTRAST,26077577,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI FOREARM LT W/O CONTRAST,26077584,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI FOREARM LT W CONTRAST,26077585,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,334.31,1113.5,
MRI HAND LT WO CONTRAST,26077586,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI HAND LT W CONTRAST,26077587,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,334.31,1113.5,
MRI HAND LT W  & W/O CONTRAST,26077588,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI FINGER  LT W/O CONTRAST,26077589,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI HUMERUS  LT W/O CONTRAST,26077594,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI HUMERUS  LT W CONTRAST,26077595,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,1310.00,524.00,,750,100,,,case rate,pays based on per visit rate,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,786,60,,628.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,334.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,917,70,,733.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,419.2,32,,335.36,percent of total billed charges,32% of total billed charges,334.31,1113.5,
MRI HUMERUS  LT W/WO CONTRAST,26077596,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,408.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,408.26,2031.08,
MRI SCAPULA LT W/O CONTRAST,26077617,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI SHOULDER  LT W/O CONTRAST,26077618,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRI SHOULDER LT W CONTRAST,26077619,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI SHOULDER LT W&W/O CONTRAST,26077620,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI THUMB LT W/O CONTRAST,26077624,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,1200.00,480.00,,750,100,,,case rate,pays based on per visit rate,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,287.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,287.43,1020,
MRI WRIST RT W & W/O CONTRAST,26077625,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI WRIST ARTHROGRAM  LT W CONTRAST,26077626,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,1266.00,506.40,,750,100,,,case rate,pays based on per visit rate,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,311.56,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,311.56,1076.1,
MRI THUMB LT W & W/O CONTRAST,26077628,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,2240.00,896.00,,750,100,,,case rate,pays based on per visit rate,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1344,60,,1075.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1904,85,,1523.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,1568,70,,1254.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,716.8,32,,573.44,percent of total billed charges,32% of total billed charges,379.01,2031.08,
MRI WRIST LT W/O CONTRAST,26077629,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,1120.00,448.00,,750,100,,,case rate,pays based on per visit rate,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,1015.54,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,672,60,,537.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,179.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,784,70,,627.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,358.4,32,,286.72,percent of total billed charges,32% of total billed charges,179.55,1015.54,
MRA UPPER EXTERMITY LT W &  W/O CONTRAST,26077641,CDM,610,RC,C8936,HCPCS,OUTPATIENT,,,1552.00,620.80,,750,100,,,case rate,pays based on per visit rate,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931.2,60,,744.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,620.8,40,,496.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1319.2,85,,1055.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,1086.4,70,,869.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,32,,397.31,percent of total billed charges,32% of total billed charges,496.64,1319.2,
NM ULTRA-TAG PER KIT,27000555,CDM,272,RC,,,OUTPATIENT,,,309.00,123.60,,,,,,other ,not seperately reimbursable,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,185.4,60,,148.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.6,40,,98.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,216.3,70,,173.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,98.88,32,,79.1,percent of total billed charges,32% of total billed charges,98.88,262.65,
NM AEROSOL VENT KIT,27000556,CDM,271,RC,,,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
NM MAA PER DOSE,27001094,CDM,343,RC,A9540,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
NM CHOLETEC PER DOSE up to 15 MILLICURIE,27001097,CDM,343,RC,A9537,HCPCS,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,157.25,
NM DTPA PER DOSE,27001098,CDM,343,RC,A9539,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
NM SULFUR COLLID UP TO 10 MILLICURES,27001202,CDM,343,RC,A9541,HCPCS,OUTPATIENT,,,456.00,182.40,,,,,,other ,not seperately reimbursable,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273.6,60,,218.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,319.2,70,,255.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,145.92,32,,116.74,percent of total billed charges,32% of total billed charges,145.92,387.6,
NM GALLIUM PER mCi,27003002,CDM,343,RC,A9556,HCPCS,OUTPATIENT,,,186.00,74.40,,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.6,60,,89.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,130.2,70,,104.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,32,,47.62,percent of total billed charges,32% of total billed charges,59.52,158.1,
NM MAG-3 PER DOSE UP TO 15 MILLICURIES,27004641,CDM,343,RC,A9562,HCPCS,OUTPATIENT,,,1710.00,684.00,,,,,,other ,not seperately reimbursable,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1026,60,,820.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,1197,70,,957.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,547.2,32,,437.76,percent of total billed charges,32% of total billed charges,547.2,1453.5,
NM CARDIOLITE PER STUDY DOSE,27009500,CDM,343,RC,A9500,HCPCS,OUTPATIENT,,,354.00,141.60,,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.4,60,,169.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,300.9,85,,240.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,247.8,70,,198.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,32,,90.62,percent of total billed charges,32% of total billed charges,113.28,300.9,
NM HDP PER DOSE up to 30 MILLICURIES,27009503,CDM,343,RC,A9503,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
NM THALLIUM PER mCi,27009505,CDM,343,RC,A9505,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
TC-99M DISOFENIN STUDY DOSE UP TO 15 mCi,27009510,CDM,343,RC,A9510,HCPCS,OUTPATIENT,,,58.97,23.59,,,,,,other ,not seperately reimbursable,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.38,60,,28.3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,50.12,85,,40.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,41.28,70,,33.02,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,18.87,32,,15.1,percent of total billed charges,32% of total billed charges,18.87,50.12,
TC-99M PERTECHNETATE DX DOSE UP TO 25 mC,27009512,CDM,343,RC,A9512,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
TC-99M PYROPHOSPHATE DX STUDY DOSE UP TO,27009538,CDM,343,RC,A9538,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
TC-99M OXIDRONATE STUDY DOSE UP TO 30 mM,27009561,CDM,343,RC,A9561,HCPCS,OUTPATIENT,,,92.00,36.80,,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,60,,44.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,64.4,70,,51.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,32,,23.55,percent of total billed charges,32% of total billed charges,29.44,78.2,
NM THALLIUM PER mCi,27009599,CDM,343,RC,A9505,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
NM THYROID IMAGING W/UP,27078006,CDM,341,RC,78012,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,95.91,272,,,fee schedule,272% of BCBS fee schedule,95.91,272,,,fee schedule,272% of BCBS fee schedule,95.91,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,87.38,552.5,
NM THYROID UPTAKE&SCAN,27078007,CDM,341,RC,78014,HCPCS,OUTPATIENT,,,1315.00,526.00,,,,,,other ,not seperately reimbursable,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,227.17,272,,,fee schedule,272% of BCBS fee schedule,227.17,272,,,fee schedule,272% of BCBS fee schedule,227.17,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,789,60,,631.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,247,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,1117.75,85,,894.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,920.5,70,,736.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,420.8,32,,336.64,percent of total billed charges,32% of total billed charges,227.17,1117.75,
NM THYROID SCAN ONLY,27078010,CDM,341,RC,78013,HCPCS,OUTPATIENT,,,960.00,384.00,,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,179.66,272,,,fee schedule,272% of BCBS fee schedule,179.66,272,,,fee schedule,272% of BCBS fee schedule,179.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,576,60,,460.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,203.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,816,85,,652.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,672,70,,537.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,179.66,816,
NM PARATHYROID SCAN,27078070,CDM,341,RC,78070,HCPCS,OUTPATIENT,,,960.00,384.00,,111.54,80,,,fee schedule,80% of Aetna fee schedule,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,164.7,272,,,fee schedule,272% of BCBS fee schedule,164.7,272,,,fee schedule,272% of BCBS fee schedule,164.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,576,60,,460.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,292.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,816,85,,652.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,672,70,,537.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,111.54,816,
*NM LIVER imaging static only,27078201,CDM,341,RC,78201,HCPCS,OUTPATIENT,,,918.00,367.20,,139.75,80,,,fee schedule,80% of Aetna fee schedule,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,215.1,272,,,fee schedule,272% of BCBS fee schedule,215.1,272,,,fee schedule,272% of BCBS fee schedule,215.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,550.8,60,,440.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,196.23,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,780.3,85,,624.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,642.6,70,,514.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,293.76,32,,235.01,percent of total billed charges,32% of total billed charges,139.75,780.3,
NM LIVER SPECT HEAGIOMA,27078205,CDM,341,RC,78831,HCPCS,OUTPATIENT,,,759.00,303.60,,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,466.67,272,,,fee schedule,272% of BCBS fee schedule,466.67,272,,,fee schedule,272% of BCBS fee schedule,466.67,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,455.4,60,,364.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,713.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,531.3,70,,425.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,32,,194.3,percent of total billed charges,32% of total billed charges,242.88,713.58,
*NM LIVER IMAGING SPECT W/VASCULAR FLOW,27078206,CDM,341,RC,78206,HCPCS,OUTPATIENT,,,915.00,366.00,,250.36,80,,,fee schedule,80% of Aetna fee schedule,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,549,60,,439.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,777.75,85,,622.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,640.5,70,,512.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,292.8,32,,234.24,percent of total billed charges,32% of total billed charges,250.36,777.75,
NM LIVER & SPLEEN SCAN,27078215,CDM,341,RC,78215,HCPCS,OUTPATIENT,,,960.00,384.00,,139.7,80,,,fee schedule,80% of Aetna fee schedule,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,265.5,272,,,fee schedule,272% of BCBS fee schedule,265.5,272,,,fee schedule,272% of BCBS fee schedule,265.5,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,576,60,,460.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,199.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,816,85,,652.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,672,70,,537.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,139.7,816,
NM HIDA SCAN W/PHARM,27078223,CDM,341,RC,78227,HCPCS,OUTPATIENT,,,1200.00,480.00,,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,332,272,,,fee schedule,272% of BCBS fee schedule,332,272,,,fee schedule,272% of BCBS fee schedule,332,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,720,60,,576,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,453.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,1020,85,,816,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,840,70,,672,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,384,32,,307.2,percent of total billed charges,32% of total billed charges,384,32,,307.2,percent of total billed charges,32% of total billed charges,332,1020,
NM HIDA SCAN,27078226,CDM,341,RC,78226,HCPCS,OUTPATIENT,,,852.00,340.80,,,,,,other ,not seperately reimbursable,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,332,272,,,fee schedule,272% of BCBS fee schedule,332,272,,,fee schedule,272% of BCBS fee schedule,332,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,511.2,60,,408.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,333.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,724.2,85,,579.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,596.4,70,,477.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,272.64,32,,218.11,percent of total billed charges,32% of total billed charges,272.64,724.2,
NM GASTRIC MUCOSA IMAG,27078261,CDM,341,RC,78261,HCPCS,OUTPATIENT,,,710.00,284.00,,181.77,80,,,fee schedule,80% of Aetna fee schedule,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,372.4,272,,,fee schedule,272% of BCBS fee schedule,372.4,272,,,fee schedule,272% of BCBS fee schedule,372.4,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,426,60,,340.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,203.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,497,70,,397.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,181.77,603.5,
NM GASTROESOPHAGEAL REFX,27078262,CDM,341,RC,78262,HCPCS,OUTPATIENT,,,710.00,284.00,,177.52,80,,,fee schedule,80% of Aetna fee schedule,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,385.89,272,,,fee schedule,272% of BCBS fee schedule,385.89,272,,,fee schedule,272% of BCBS fee schedule,385.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,426,60,,340.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,244.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,603.5,85,,482.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,497,70,,397.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,227.2,32,,181.76,percent of total billed charges,32% of total billed charges,177.52,603.5,
NM GASTRIC EMPTYING,27078264,CDM,341,RC,78264,HCPCS,OUTPATIENT,,,750.00,300.00,,208.97,80,,,fee schedule,80% of Aetna fee schedule,240,32,,192,percent of total billed charges,32% of total billed charges,240,32,,192,percent of total billed charges,32% of total billed charges,374.14,272,,,fee schedule,272% of BCBS fee schedule,374.14,272,,,fee schedule,272% of BCBS fee schedule,374.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,450,60,,360,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,336.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,637.5,85,,510,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,240,32,,192,percent of total billed charges,32% of total billed charges,525,70,,420,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,240,32,,192,percent of total billed charges,32% of total billed charges,240,32,,192,percent of total billed charges,32% of total billed charges,208.97,637.5,
NM GI BLEED SCAN,27078278,CDM,341,RC,78278,HCPCS,OUTPATIENT,,,900.00,360.00,,253.35,80,,,fee schedule,80% of Aetna fee schedule,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,442.38,272,,,fee schedule,272% of BCBS fee schedule,442.38,272,,,fee schedule,272% of BCBS fee schedule,442.38,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,540,60,,432,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,345.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,765,85,,612,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,630,70,,504,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,253.35,765,
NM MECKLES SCAN,27078290,CDM,341,RC,78290,HCPCS,OUTPATIENT,,,885.00,354.00,,242.24,80,,,fee schedule,80% of Aetna fee schedule,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,275.51,272,,,fee schedule,272% of BCBS fee schedule,275.51,272,,,fee schedule,272% of BCBS fee schedule,275.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,531,60,,424.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,341.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,752.25,85,,601.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,619.5,70,,495.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,283.2,32,,226.56,percent of total billed charges,32% of total billed charges,242.24,752.25,
NM BONE SCAN LIMITED,27078300,CDM,341,RC,78300,HCPCS,OUTPATIENT,,,960.00,384.00,,130.22,80,,,fee schedule,80% of Aetna fee schedule,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,226.85,272,,,fee schedule,272% of BCBS fee schedule,226.85,272,,,fee schedule,272% of BCBS fee schedule,226.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,576,60,,460.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,816,85,,652.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,672,70,,537.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,307.2,32,,245.76,percent of total billed charges,32% of total billed charges,130.22,816,
NM BONE SCAN WHOLE BDY,27078306,CDM,341,RC,78306,HCPCS,OUTPATIENT,,,720.00,288.00,,182.3,80,,,fee schedule,80% of Aetna fee schedule,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,387.63,272,,,fee schedule,272% of BCBS fee schedule,387.63,272,,,fee schedule,272% of BCBS fee schedule,387.63,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,432,60,,345.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,293.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,504,70,,403.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,182.3,612,
NM BONE SCAN 3 PHASE,27078315,CDM,341,RC,78315,HCPCS,OUTPATIENT,,,900.00,360.00,,252.89,80,,,fee schedule,80% of Aetna fee schedule,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,433.24,272,,,fee schedule,272% of BCBS fee schedule,433.24,272,,,fee schedule,272% of BCBS fee schedule,433.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,540,60,,432,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,341.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,765,85,,612,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,630,70,,504,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,288,32,,230.4,percent of total billed charges,32% of total billed charges,288,32,,230.4,percent of total billed charges,32% of total billed charges,252.89,765,
NM BONE SCAN TOMO,27078320,CDM,341,RC,78803,HCPCS,OUTPATIENT,,,720.00,288.00,,245.61,80,,,fee schedule,80% of Aetna fee schedule,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,594.02,272,,,fee schedule,272% of BCBS fee schedule,594.02,272,,,fee schedule,272% of BCBS fee schedule,594.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,432,60,,345.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,382.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,504,70,,403.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,32,,184.32,percent of total billed charges,32% of total billed charges,230.4,612,
NM ACUTE VENOUS THRONB,27078456,CDM,341,RC,78491,HCPCS,OUTPATIENT,,,4285.00,1714.00,,,,,,other ,not seperately reimbursable,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2571,60,,2056.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,3642.25,85,,2913.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,2999.5,70,,2399.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,1371.2,32,,1096.96,percent of total billed charges,32% of total billed charges,1371.2,3642.25,
*NM MYOCARDIAL PERFUSION,27078460,CDM,341,RC,78453,HCPCS,OUTPATIENT,,,784.00,313.60,,223,80,,,fee schedule,80% of Aetna fee schedule,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,215.1,272,,,fee schedule,272% of BCBS fee schedule,215.1,272,,,fee schedule,272% of BCBS fee schedule,215.1,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,470.4,60,,376.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,284.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,666.4,85,,533.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,548.8,70,,439.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,215.1,666.4,
*NM MULTI STUDIES (PLANAR) REST/STRESS,27078461,CDM,341,RC,78454,HCPCS,OUTPATIENT,,,471.00,188.40,,321.45,80,,,fee schedule,80% of Aetna fee schedule,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,428.89,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,282.6,60,,226.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,424.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,329.7,70,,263.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,32,,120.58,percent of total billed charges,32% of total billed charges,150.72,428.89,
****NM CARDIAC SINGLE STDY,27078464,CDM,341,RC,78451,HCPCS,OUTPATIENT,,,784.00,313.60,,259.62,80,,,fee schedule,80% of Aetna fee schedule,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,470.4,60,,376.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,315.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,666.4,85,,533.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,548.8,70,,439.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,666.4,
NM CARDIAC REST&STRESS,27078465,CDM,341,RC,78452,HCPCS,OUTPATIENT,,,3186.00,1274.40,,362.75,80,,,fee schedule,80% of Aetna fee schedule,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,1068.12,272,,,fee schedule,272% of BCBS fee schedule,1068.12,272,,,fee schedule,272% of BCBS fee schedule,1068.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1911.6,60,,1529.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,455.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,2708.1,85,,2166.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,2230.2,70,,1784.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,1019.52,32,,815.62,percent of total billed charges,32% of total billed charges,362.75,2708.1,
NM MUGA SCAN,27078472,CDM,341,RC,78472,HCPCS,OUTPATIENT,,,866.00,346.40,,170.76,80,,,fee schedule,80% of Aetna fee schedule,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,500.59,272,,,fee schedule,272% of BCBS fee schedule,500.59,272,,,fee schedule,272% of BCBS fee schedule,500.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,519.6,60,,415.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,208.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,606.2,70,,484.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,277.12,32,,221.7,percent of total billed charges,32% of total billed charges,170.76,736.1,
NM MUGA SCAN BLOOD POOLING,27078496,CDM,341,RC,78496,HCPCS,OUTPATIENT,,,115.00,46.00,,33.26,80,,,fee schedule,80% of Aetna fee schedule,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,22.95,97.75,
NM LUNG PERFUSION,27078580,CDM,341,RC,78580,HCPCS,OUTPATIENT,,,600.00,240.00,,153.13,80,,,fee schedule,80% of Aetna fee schedule,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,311.58,272,,,fee schedule,272% of BCBS fee schedule,311.58,272,,,fee schedule,272% of BCBS fee schedule,311.58,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,360,60,,288,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,231.16,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,420,70,,336,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,153.13,510,
NM LUNG AEROSOL,27078587,CDM,341,RC,78579,HCPCS,OUTPATIENT,,,600.00,240.00,,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,235.52,272,,,fee schedule,272% of BCBS fee schedule,235.52,272,,,fee schedule,272% of BCBS fee schedule,235.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,360,60,,288,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,188.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,420,70,,336,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,188.91,510,
NM LUNG PERFUSION & AEROSOL,27078588,CDM,341,RC,78582,HCPCS,OUTPATIENT,,,920.00,368.00,,,,,,other ,not seperately reimbursable,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,289.84,272,,,fee schedule,272% of BCBS fee schedule,289.84,272,,,fee schedule,272% of BCBS fee schedule,289.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,552,60,,441.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,323.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,782,85,,625.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,644,70,,515.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,294.4,32,,235.52,percent of total billed charges,32% of total billed charges,289.84,782,
NM QUANTITATIVE LUNG,27078596,CDM,341,RC,78598,HCPCS,OUTPATIENT,,,925.00,370.00,,,,,,other ,not seperately reimbursable,296,32,,236.8,percent of total billed charges,32% of total billed charges,296,32,,236.8,percent of total billed charges,32% of total billed charges,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,641.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,555,60,,444,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,303.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,296,32,,236.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,296,32,,236.8,percent of total billed charges,32% of total billed charges,786.25,85,,629,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,296,32,,236.8,percent of total billed charges,32% of total billed charges,296,32,,236.8,percent of total billed charges,32% of total billed charges,647.5,70,,518,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,296,32,,236.8,percent of total billed charges,32% of total billed charges,296,32,,236.8,percent of total billed charges,32% of total billed charges,296,786.25,
NM KIDNEY IMAGING,27078700,CDM,341,RC,78700,HCPCS,OUTPATIENT,,,733.00,293.20,,126.62,80,,,fee schedule,80% of Aetna fee schedule,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,275.51,272,,,fee schedule,272% of BCBS fee schedule,275.51,272,,,fee schedule,272% of BCBS fee schedule,275.51,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,439.8,60,,351.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,172.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,623.05,85,,498.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,513.1,70,,410.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,126.62,623.05,
NM RENAL FLOW & FUNCT,27078707,CDM,341,RC,78707,HCPCS,OUTPATIENT,,,930.00,372.00,,167.92,80,,,fee schedule,80% of Aetna fee schedule,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,405.44,272,,,fee schedule,272% of BCBS fee schedule,405.44,272,,,fee schedule,272% of BCBS fee schedule,405.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,558,60,,446.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,215.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,790.5,85,,632.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,651,70,,520.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,167.92,790.5,
NM RENAL MAG 3 W/PHARM,27078708,CDM,341,RC,78708,HCPCS,OUTPATIENT,,,930.00,372.00,,121.5,80,,,fee schedule,80% of Aetna fee schedule,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,439.12,272,,,fee schedule,272% of BCBS fee schedule,439.12,272,,,fee schedule,272% of BCBS fee schedule,439.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,558,60,,446.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,790.5,85,,632.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,651,70,,520.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,121.5,790.5,
NM RENAL CAPTOPRIL MULT,27078709,CDM,341,RC,78709,HCPCS,OUTPATIENT,,,930.00,372.00,,269.89,80,,,fee schedule,80% of Aetna fee schedule,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,439.12,272,,,fee schedule,272% of BCBS fee schedule,439.12,272,,,fee schedule,272% of BCBS fee schedule,439.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,558,60,,446.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,347.55,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,790.5,85,,632.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,651,70,,520.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,297.6,32,,238.08,percent of total billed charges,32% of total billed charges,269.89,790.5,
NM KIDNEY FUNCTION,27078725,CDM,341,RC,78725,HCPCS,OUTPATIENT,,,452.00,180.80,,75.18,80,,,fee schedule,80% of Aetna fee schedule,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,162.08,272,,,fee schedule,272% of BCBS fee schedule,162.08,272,,,fee schedule,272% of BCBS fee schedule,162.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,271.2,60,,216.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,384.2,85,,307.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,316.4,70,,253.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,144.64,32,,115.71,percent of total billed charges,32% of total billed charges,75.18,384.2,
NM TESTICULAR SCAN,27078761,CDM,341,RC,78761,HCPCS,OUTPATIENT,,,733.00,293.20,,155.77,80,,,fee schedule,80% of Aetna fee schedule,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,289.84,272,,,fee schedule,272% of BCBS fee schedule,289.84,272,,,fee schedule,272% of BCBS fee schedule,289.84,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,439.8,60,,351.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,204.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,623.05,85,,498.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,513.1,70,,410.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,234.56,32,,187.65,percent of total billed charges,32% of total billed charges,155.77,623.05,
NM GALLIUM SCAN LIMITED,27078800,CDM,341,RC,78800,HCPCS,OUTPATIENT,,,820.00,328.00,,135.78,80,,,fee schedule,80% of Aetna fee schedule,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,307.66,272,,,fee schedule,272% of BCBS fee schedule,307.66,272,,,fee schedule,272% of BCBS fee schedule,307.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,492,60,,393.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,255.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,697,85,,557.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,574,70,,459.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,135.78,697,
NM GALLIUM WHOLE BODY,27078802,CDM,341,RC,78802,HCPCS,OUTPATIENT,,,1155.00,462.00,,233.35,80,,,fee schedule,80% of Aetna fee schedule,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,502.33,272,,,fee schedule,272% of BCBS fee schedule,502.33,272,,,fee schedule,272% of BCBS fee schedule,502.33,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,693,60,,554.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,313.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,981.75,85,,785.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,808.5,70,,646.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,369.6,32,,295.68,percent of total billed charges,32% of total billed charges,233.35,981.75,
NM GALLIUM TOMO,27078803,CDM,341,RC,78804,HCPCS,OUTPATIENT,,,3351.00,1340.40,,410.46,80,,,fee schedule,80% of Aetna fee schedule,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2010.6,60,,1608.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,696.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,2848.35,85,,2278.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,2345.7,70,,1876.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,1072.32,32,,857.86,percent of total billed charges,32% of total billed charges,410.46,2848.35,
NM SN PYP COLD KIT UP TO 30 MILLICURIES,27078804,CDM,343,RC,A9560,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
NM TECHNETIUM TC99M UP TO 30 MILLICURIES,27078805,CDM,343,RC,A9503,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
NM WBC LIMITED PROC,27078806,CDM,342,RC,78800,HCPCS,OUTPATIENT,,,3552.00,1420.80,,135.78,80,,,fee schedule,80% of Aetna fee schedule,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,307.66,272,,,fee schedule,272% of BCBS fee schedule,307.66,272,,,fee schedule,272% of BCBS fee schedule,307.66,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,2131.2,60,,1704.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,255.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,3019.2,85,,2415.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,2486.4,70,,1989.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,1136.64,32,,909.31,percent of total billed charges,32% of total billed charges,135.78,3019.2,
"NM RADIOPHARMACEUTICAL LOCAL,TOMO SPECT",27078807,CDM,342,RC,78803,HCPCS,OUTPATIENT,,,1440.00,576.00,,245.61,80,,,fee schedule,80% of Aetna fee schedule,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,594.02,272,,,fee schedule,272% of BCBS fee schedule,594.02,272,,,fee schedule,272% of BCBS fee schedule,594.02,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,864,60,,691.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,382.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,1224,85,,979.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,1008,70,,806.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,460.8,32,,368.64,percent of total billed charges,32% of total billed charges,245.61,1224,
CARDIAC BLOOD POOL IMG SNGL REST/STRESS,27078808,CDM,341,RC,78472,HCPCS,OUTPATIENT,,,784.00,313.60,,170.76,80,,,fee schedule,80% of Aetna fee schedule,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,500.59,272,,,fee schedule,272% of BCBS fee schedule,500.59,272,,,fee schedule,272% of BCBS fee schedule,500.59,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,470.4,60,,376.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,208.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,666.4,85,,533.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,548.8,70,,439.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,250.88,32,,200.7,percent of total billed charges,32% of total billed charges,170.76,666.4,
"NM BONE AND/OR JOINT IMAGING, LIMITED",27078809,CDM,341,RC,78300,HCPCS,OUTPATIENT,,,942.00,376.80,,130.22,80,,,fee schedule,80% of Aetna fee schedule,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,226.85,272,,,fee schedule,272% of BCBS fee schedule,226.85,272,,,fee schedule,272% of BCBS fee schedule,226.85,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,565.2,60,,452.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,227.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,800.7,85,,640.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,659.4,70,,527.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,301.44,32,,241.15,percent of total billed charges,32% of total billed charges,130.22,800.7,
US FINE NEEDLE ASPIRATION W/IMAGING GUID,28010022,CDM,402,RC,10005,HCPCS,OUTPATIENT,,,1286.00,514.40,,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771.6,60,,617.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,174.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,1093.1,85,,874.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,900.2,70,,720.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,411.52,32,,329.22,percent of total billed charges,32% of total billed charges,174.44,1093.1,
US OB NUCHAL TRANSLUCENCY  1ST TRI,28076813,CDM,402,RC,76813,HCPCS,OUTPATIENT,,,205.00,82.00,,95.27,80,,,fee schedule,80% of Aetna fee schedule,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123,60,,98.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,75.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,143.5,70,,114.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,174.25,
US OB NUCHAL TRANSLUCENCY  EA ADD'L,28076814,CDM,402,RC,76814,HCPCS,OUTPATIENT,,,100.00,40.00,,62.66,80,,,fee schedule,80% of Aetna fee schedule,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
US OB FETAL VIABIALITY,28076815,CDM,402,RC,76815,HCPCS,OUTPATIENT,,,450.00,180.00,,67.45,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,61.95,382.5,
US URINARY BLADDER,28076857,CDM,402,RC,76857,HCPCS,OUTPATIENT,,,240.00,96.00,,71.35,80,,,fee schedule,80% of Aetna fee schedule,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.86,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,29.86,204,
US GUIDANCE VASCULAR,28076937,CDM,402,RC,76937,HCPCS,OUTPATIENT,,,70.00,28.00,,26.81,80,,,fee schedule,80% of Aetna fee schedule,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
US ECHOENCEPHLOGRAPHY,28077050,CDM,402,RC,76506,HCPCS,OUTPATIENT,,,489.00,195.60,,91.05,80,,,fee schedule,80% of Aetna fee schedule,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,293.4,60,,234.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,104.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,415.65,85,,332.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,342.3,70,,273.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,156.48,32,,125.18,percent of total billed charges,32% of total billed charges,91.05,415.65,
US PHYS/REST ONLY UPPER ART,28093923,CDM,920,RC,93923,HCPCS,OUTPATIENT,,,405.00,162.00,,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,214.69,272,,,fee schedule,272% of BCBS fee schedule,214.69,272,,,fee schedule,272% of BCBS fee schedule,214.69,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,243,60,,194.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,344.25,85,,275.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,283.5,70,,226.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,32,,103.68,percent of total billed charges,32% of total billed charges,129.6,344.25,
US UPPER EXT DUPLEX ART UNILAT,28093931,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,447.00,178.80,,,,,,other ,not seperately reimbursable,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,268.2,60,,214.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,312.9,70,,250.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,143.04,32,,114.43,percent of total billed charges,32% of total billed charges,123.9,379.95,
US VEINS MAPPING BILATERIAL,28093970,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,737.00,294.80,,,,,,other ,not seperately reimbursable,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,401.53,272,,,fee schedule,272% of BCBS fee schedule,401.53,272,,,fee schedule,272% of BCBS fee schedule,401.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,442.2,60,,353.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,190.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,626.45,85,,501.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,515.9,70,,412.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,235.84,32,,188.67,percent of total billed charges,32% of total billed charges,190.11,626.45,
US VEINS MAPPING UNI LT,28093971,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,467.00,186.80,,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,280.2,60,,224.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,326.9,70,,261.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,120.65,396.95,
US VEINS MAPPING UNI RT,28093977,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,467.00,186.80,,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,280.2,60,,224.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,326.9,70,,261.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,149.44,32,,119.55,percent of total billed charges,32% of total billed charges,120.65,396.95,
CT SHOULDER LT WO CONTRAST,28505055,CDM,350,RC,73200,HCPCS,OUTPATIENT,,,558.00,223.20,LT,746.82,100,,,case rate,pays based on per visit rate,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,450.19,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,334.8,60,,267.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,149.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,474.3,85,,379.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,390.6,70,,312.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,178.56,32,,142.85,percent of total billed charges,32% of total billed charges,149.28,746.82,
NM RENOGRAM (DYNAMIC KIDNEY STUDY),28701050,CDM,340,RC,78708,HCPCS,OUTPATIENT,,,484.00,193.60,,121.5,80,,,fee schedule,80% of Aetna fee schedule,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,439.12,272,,,fee schedule,272% of BCBS fee schedule,439.12,272,,,fee schedule,272% of BCBS fee schedule,439.12,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,290.4,60,,232.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,144.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,411.4,85,,329.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,338.8,70,,271.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,154.88,32,,123.9,percent of total billed charges,32% of total billed charges,121.5,439.12,
US SPINE AND CONTENTS,28803000,CDM,402,RC,76800,HCPCS,OUTPATIENT,,,408.00,163.20,,106.94,80,,,fee schedule,80% of Aetna fee schedule,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,244.8,60,,195.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,285.6,70,,228.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,130.56,32,,104.45,percent of total billed charges,32% of total billed charges,106.94,346.8,
US PELVIC OB-1ST TRIM,28803001,CDM,402,RC,76801,HCPCS,OUTPATIENT,,,450.00,180.00,,95.34,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,86.73,382.5,
US OB FETUS 14 WKS+DETAILED,28803100,CDM,402,RC,76811,HCPCS,OUTPATIENT,,,444.00,177.60,,141.27,80,,,fee schedule,80% of Aetna fee schedule,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.4,60,,213.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,102.4,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,310.8,70,,248.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,142.08,32,,113.66,percent of total billed charges,32% of total billed charges,102.4,377.4,
US OB TRASNSVAGINAL,28803200,CDM,402,RC,76817,HCPCS,OUTPATIENT,,,450.00,180.00,,76.82,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,70.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,70.08,382.5,
*US FETAL BIOPHYSICAL W/NON-STRESS,28803300,CDM,402,RC,76819,HCPCS,OUTPATIENT,,,160.00,64.00,,67.41,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,57.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
US ECHO STRESS MEDS,28803330,CDM,483,RC,93015,HCPCS,OUTPATIENT,,,261.00,104.40,,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.6,60,,125.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,182.7,70,,146.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,221.85,
US OB EA ADD FETUS +14 WKS DETAILED,28803340,CDM,402,RC,76812,HCPCS,OUTPATIENT,,,366.00,146.40,,160.98,80,,,fee schedule,80% of Aetna fee schedule,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.6,60,,175.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,132.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,311.1,85,,248.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,256.2,70,,204.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,311.1,
US OB FETAL LIMITED,28803350,CDM,402,RC,76815,HCPCS,OUTPATIENT,,,450.00,180.00,,67.45,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,61.95,382.5,
US RENAL TRASNSPLANTED KIDNEY,28803360,CDM,402,RC,,,OUTPATIENT,,,241.00,96.40,,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.6,60,,115.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,204.85,85,,163.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,168.7,70,,134.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,32,,61.7,percent of total billed charges,32% of total billed charges,77.12,204.85,
US SONOHYSTEROGRAPHY,28803400,CDM,402,RC,76831,HCPCS,OUTPATIENT,,,450.00,180.00,,94.89,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,150.58,272,,,fee schedule,272% of BCBS fee schedule,150.58,272,,,fee schedule,272% of BCBS fee schedule,150.58,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,100.94,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,94.89,382.5,
US INFANT HIPS,28803600,CDM,402,RC,76885,HCPCS,OUTPATIENT,,,336.00,134.40,,108.97,80,,,fee schedule,80% of Aetna fee schedule,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,150.58,272,,,fee schedule,272% of BCBS fee schedule,150.58,272,,,fee schedule,272% of BCBS fee schedule,150.58,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,201.6,60,,161.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,235.2,70,,188.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,285.6,
US GUIDED FLUID COLL,28803700,CDM,402,RC,33016,HCPCS,OUTPATIENT,,,160.00,64.00,,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,200,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,200,
US M-MODE/REALTIME ECHO COMP,28804419,CDM,483,RC,93307,HCPCS,OUTPATIENT,,,392.00,156.80,,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,355.04,272,,,fee schedule,272% of BCBS fee schedule,355.04,272,,,fee schedule,272% of BCBS fee schedule,355.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,235.2,60,,188.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,116.59,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,274.4,70,,219.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,125.44,32,,100.35,percent of total billed charges,32% of total billed charges,116.59,355.04,
US GALL BLADDER,28804427,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,450.00,180.00,,79.62,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,73.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,73.33,382.5,
US DUP LOW EXT ARTERIAL -BIL,28804428,CDM,921,RC,93925,HCPCS,OUTPATIENT,,,845.00,338.00,,,,,,other ,not seperately reimbursable,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,362.44,272,,,fee schedule,272% of BCBS fee schedule,362.44,272,,,fee schedule,272% of BCBS fee schedule,362.44,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,507,60,,405.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,251.48,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,718.25,85,,574.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,591.5,70,,473.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,270.4,32,,216.32,percent of total billed charges,32% of total billed charges,251.48,718.25,
*US LOW EXT ART RT DUP UNI,28804429,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,427.00,170.80,,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,256.2,60,,204.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,128.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,298.9,70,,239.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,136.64,32,,109.31,percent of total billed charges,32% of total billed charges,128.99,362.95,
US DUPLEX VEINS-EXT UP BIL,28804430,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,660.00,264.00,,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,401.53,272,,,fee schedule,272% of BCBS fee schedule,401.53,272,,,fee schedule,272% of BCBS fee schedule,401.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,396,60,,316.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,190.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,561,85,,448.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,462,70,,369.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,190.11,561,
US DUPLEX VEINS-UP RT EXT UNIL,28804431,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,390.00,156.00,,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,120.65,331.5,
US AORTA IVC ILLAC COMP,28804432,CDM,921,RC,93978,HCPCS,OUTPATIENT,,,615.00,246.00,,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,373.73,272,,,fee schedule,272% of BCBS fee schedule,373.73,272,,,fee schedule,272% of BCBS fee schedule,373.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,369,60,,295.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,176.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,430.5,70,,344.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,176.33,522.75,
US AORTA IVC ILLIAC DUPLEX LIMITED,28804433,CDM,921,RC,93979,HCPCS,OUTPATIENT,,,435.00,174.00,,,,,,other ,not seperately reimbursable,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,248.58,272,,,fee schedule,272% of BCBS fee schedule,248.58,272,,,fee schedule,272% of BCBS fee schedule,248.58,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,261,60,,208.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,115.78,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,369.75,85,,295.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,304.5,70,,243.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,139.2,32,,111.36,percent of total billed charges,32% of total billed charges,115.78,369.75,
US DUPLEX UP EXT ARTERIES BILAT,28804434,CDM,921,RC,93930,HCPCS,OUTPATIENT,,,670.00,268.00,,,,,,other ,not seperately reimbursable,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,384.15,272,,,fee schedule,272% of BCBS fee schedule,384.15,272,,,fee schedule,272% of BCBS fee schedule,384.15,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,402,60,,321.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,195.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,569.5,85,,455.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,469,70,,375.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,214.4,32,,171.52,percent of total billed charges,32% of total billed charges,195.01,569.5,
US LIVER,28804435,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,450.00,180.00,,79.62,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,73.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,73.33,382.5,
US DUPLEX UP EXT ARTERIES-LIMITED,28804436,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,279.00,111.60,,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,167.4,60,,133.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,195.3,70,,156.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,32,,71.42,percent of total billed charges,32% of total billed charges,89.28,252.96,
US DUPLEX VEINS-LOW RT EXT UNIL,28804437,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,390.00,156.00,,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,120.65,331.5,
US DUPLEX VEINS-LOW EXT BIL,28804438,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,660.00,264.00,,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,401.53,272,,,fee schedule,272% of BCBS fee schedule,401.53,272,,,fee schedule,272% of BCBS fee schedule,401.53,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,396,60,,316.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,190.11,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,561,85,,448.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,462,70,,369.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,190.11,561,
US SPLEEN,28804443,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,450.00,180.00,,79.62,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,73.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,73.33,382.5,
FISTUL/SINUS TRACT,28804444,CDM,320,RC,76080,HCPCS,OUTPATIENT,,,559.00,223.60,,45.58,80,,,fee schedule,80% of Aetna fee schedule,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,335.4,60,,268.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,391.3,70,,313.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,178.88,32,,143.1,percent of total billed charges,32% of total billed charges,43.68,475.15,
US AORTA IVC ILLIAC DUPLEX COMPLETE,28804445,CDM,921,RC,93978,HCPCS,OUTPATIENT,,,615.00,246.00,,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,373.73,272,,,fee schedule,272% of BCBS fee schedule,373.73,272,,,fee schedule,272% of BCBS fee schedule,373.73,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,369,60,,295.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,176.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,430.5,70,,344.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,196.8,32,,157.44,percent of total billed charges,32% of total billed charges,176.33,522.75,
"US DUPLEX SCAN, LIMIT",28804446,CDM,921,RC,93976,HCPCS,OUTPATIENT,,,462.00,184.80,,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,304.2,272,,,fee schedule,272% of BCBS fee schedule,304.2,272,,,fee schedule,272% of BCBS fee schedule,304.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,277.2,60,,221.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,392.7,85,,314.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,323.4,70,,258.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,143.75,392.7,
US DUPLEX RT HEMODIALYSIS ACCESS,28804447,CDM,921,RC,93990,HCPCS,OUTPATIENT,,,600.00,240.00,,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,360,60,,288,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,420,70,,336,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,130.32,510,
US RENALS TO INCLUDE BLADDER,28804468,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,450.00,180.00,,98.38,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,90.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,90.79,382.5,
US AAA SCREENING,28804475,CDM,402,RC,76706,HCPCS,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,98.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,255,
US ABDOMINAL AORTA,28804476,CDM,402,RC,76775,HCPCS,OUTPATIENT,,,450.00,180.00,,79.86,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,37.18,382.5,
US PELVIC W/ TRANSVAGL NON OB,28804483,CDM,402,RC,76856,HCPCS,OUTPATIENT,,,450.00,180.00,,93.05,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,89.98,382.5,
US PELVIC NON OB,28804484,CDM,402,RC,76856,HCPCS,OUTPATIENT,,,450.00,180.00,,93.05,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,89.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,89.98,382.5,
US SCROTUM,28804485,CDM,402,RC,76870,HCPCS,OUTPATIENT,,,450.00,180.00,,92.08,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.73,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,86.73,382.5,
US OB PLACENTA LOCAL LMT,28804518,CDM,402,RC,76815,HCPCS,OUTPATIENT,,,450.00,180.00,,67.45,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,61.95,382.5,
US FETAL BIOPHYSICAL W/O NON-STRESS,28804526,CDM,402,RC,76818,HCPCS,OUTPATIENT,,,280.00,112.00,,92.62,80,,,fee schedule,80% of Aetna fee schedule,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,146.88,272,,,fee schedule,272% of BCBS fee schedule,146.88,272,,,fee schedule,272% of BCBS fee schedule,146.88,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,168,60,,134.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,78.81,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,196,70,,156.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,78.81,238,
US PELVIC OB 14WK PLUS,28804534,CDM,402,RC,76805,HCPCS,OUTPATIENT,,,450.00,180.00,,110.9,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,107.85,382.5,
US OB FETUS EA ADDL FETUS,28804542,CDM,402,RC,76802,HCPCS,OUTPATIENT,,,210.00,84.00,,51.68,80,,,fee schedule,80% of Aetna fee schedule,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,126,60,,100.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,147,70,,117.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,25.99,190.75,
US OB EA ADDL FETUS 14 WKS +,28804545,CDM,402,RC,76810,HCPCS,OUTPATIENT,,,282.00,112.80,,74.14,80,,,fee schedule,80% of Aetna fee schedule,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,169.2,60,,135.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,50.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,239.7,85,,191.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,197.4,70,,157.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,90.24,32,,72.19,percent of total billed charges,32% of total billed charges,50.99,239.7,
US OB FETAL F/U PREVIOUS ABNOR,28804559,CDM,402,RC,76816,HCPCS,OUTPATIENT,,,450.00,180.00,,89.74,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,101.24,272,,,fee schedule,272% of BCBS fee schedule,101.24,272,,,fee schedule,272% of BCBS fee schedule,101.24,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,84.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,84.7,382.5,
US BREAST RT  LIMITED,28804567,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,378.00,151.20,,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,226.8,60,,181.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,264.6,70,,211.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,64.39,321.3,
US BREAST RT COMPLETE,28804568,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,378.00,151.20,,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,226.8,60,,181.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,84.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,264.6,70,,211.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,84.29,321.3,
US THYROID,28804575,CDM,402,RC,76536,HCPCS,OUTPATIENT,,,450.00,180.00,,90.29,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,104.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,90.29,382.5,
US CAROTID DUPLEX COMPLETE,28804580,CDM,921,RC,93880,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,360.7,272,,,fee schedule,272% of BCBS fee schedule,360.7,272,,,fee schedule,272% of BCBS fee schedule,360.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,188.09,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,188.09,552.5,
***US TREATMENT ROOM.,28804585,CDM,761,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
US NON-VENOUS (EXT),28804652,CDM,402,RC,76881,HCPCS,OUTPATIENT,,,450.00,180.00,,88.17,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,34.74,382.5,
US ABD LTD,28805101,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,450.00,180.00,,79.62,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,73.33,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,73.33,382.5,
US RENAL ARTERIES,28805108,CDM,921,RC,93976,HCPCS,OUTPATIENT,,,462.00,184.80,,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,304.2,272,,,fee schedule,272% of BCBS fee schedule,304.2,272,,,fee schedule,272% of BCBS fee schedule,304.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,277.2,60,,221.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,392.7,85,,314.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,323.4,70,,258.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,147.84,32,,118.27,percent of total billed charges,32% of total billed charges,143.75,392.7,
US RENAL ARTERIES LIMITED,28805112,CDM,921,RC,93976,HCPCS,OUTPATIENT,,,336.00,134.40,,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,304.2,272,,,fee schedule,272% of BCBS fee schedule,304.2,272,,,fee schedule,272% of BCBS fee schedule,304.2,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,201.6,60,,161.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,143.75,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,235.2,70,,188.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,32,,86.02,percent of total billed charges,32% of total billed charges,107.52,304.2,
US OPTHALMIC,28805118,CDM,402,RC,76510,HCPCS,OUTPATIENT,,,230.00,92.00,,135.35,80,,,fee schedule,80% of Aetna fee schedule,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138,60,,110.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,161,70,,128.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,73.6,32,,58.88,percent of total billed charges,32% of total billed charges,37.18,195.5,
US TRANSVAGINAL NON OB,28805120,CDM,402,RC,76830,HCPCS,OUTPATIENT,,,450.00,180.00,,93.82,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,93.82,382.5,
US ECHO REST/STRESS INC CONT MON W/SUPE,28805121,CDM,482,RC,93351,HCPCS,OUTPATIENT,,,368.00,147.20,,,,,,other ,not seperately reimbursable,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,60,,176.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,185.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,257.6,70,,206.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,117.76,32,,94.21,percent of total billed charges,32% of total billed charges,117.76,312.8,
US SOFT TISSUE EXTREMITY  NON VASCULAR,28805125,CDM,402,RC,76881,HCPCS,OUTPATIENT,,,450.00,180.00,,88.17,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.74,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,34.74,382.5,
US ECHO REST/STRESS CONTRAST AGENT,28805126,CDM,489,RC,93352,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
DEFINITY SUSPENSION PER ML,28805127,CDM,483,RC,Q9957,HCPCS,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,127.5,
ECHO W/CONTRAST,28805129,CDM,483,RC,93306,HCPCS,OUTPATIENT,,,1968.00,787.20,TC,,,,,other ,not seperately reimbursable,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1180.8,60,,944.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,1672.8,85,,1338.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,1377.6,70,,1102.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,629.76,32,,503.81,percent of total billed charges,32% of total billed charges,158.43,1672.8,
ECHO COMPLETE,28805130,CDM,483,RC,93306,HCPCS,OUTPATIENT,,,1339.00,535.60,,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.4,60,,642.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,1138.15,85,,910.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,937.3,70,,749.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,158.43,1138.15,
ECHO COLOR FLOW MAP,28805131,CDM,480,RC,93325,HCPCS,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,271.16,272,,,fee schedule,272% of BCBS fee schedule,271.16,272,,,fee schedule,272% of BCBS fee schedule,271.16,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.18,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,25.18,271.16,
US ECHO DOPPLER PULSE WAVE,28805136,CDM,483,RC,93320,HCPCS,OUTPATIENT,,,227.00,90.80,,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,158.6,272,,,fee schedule,272% of BCBS fee schedule,158.6,272,,,fee schedule,272% of BCBS fee schedule,158.6,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,136.2,60,,108.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,158.9,70,,127.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,41.24,192.95,
US ECHO REST/STRESS,28805137,CDM,482,RC,93350,HCPCS,OUTPATIENT,,,602.00,240.80,,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,164.26,272,,,fee schedule,272% of BCBS fee schedule,164.26,272,,,fee schedule,272% of BCBS fee schedule,164.26,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,361.2,60,,288.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,146.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,511.7,85,,409.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,421.4,70,,337.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,192.64,32,,154.11,percent of total billed charges,32% of total billed charges,146.25,511.7,
US SOFT TISSUE MASS HEAD AND NECK,28805138,CDM,402,RC,76536,HCPCS,OUTPATIENT,,,450.00,180.00,,90.29,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,104.19,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,90.29,382.5,
US FLUID MARKING FOR CHEST OR MEDIA,28805139,CDM,402,RC,76604,HCPCS,OUTPATIENT,,,185.00,74.00,,65,80,,,fee schedule,80% of Aetna fee schedule,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,37.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,37.58,157.25,
US GUIDED CYST ASPIRAT,28805140,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,505.00,202.00,,146.75,80,,,fee schedule,80% of Aetna fee schedule,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,303,60,,242.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,353.5,70,,282.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,33.51,429.25,
US BREAST BILATERAL,28805141,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,378.00,151.20,,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,226.8,60,,181.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,264.6,70,,211.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,64.39,321.3,
US DUPLEX UP EXT RT ARTERIES UNILAT,28805143,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,450.00,180.00,,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,123.9,382.5,
US ARTERIAL R&S,28805144,CDM,921,RC,93924,HCPCS,OUTPATIENT,,,520.00,208.00,,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,234.25,272,,,fee schedule,272% of BCBS fee schedule,234.25,272,,,fee schedule,272% of BCBS fee schedule,234.25,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,312,60,,249.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,164.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,364,70,,291.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,166.4,32,,133.12,percent of total billed charges,32% of total billed charges,164.14,442,
US CAROTID DUPLEX LIMITED,28805145,CDM,921,RC,93882,HCPCS,OUTPATIENT,,,264.00,105.60,,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,239.01,272,,,fee schedule,272% of BCBS fee schedule,239.01,272,,,fee schedule,272% of BCBS fee schedule,239.01,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,158.4,60,,126.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,124.31,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,184.8,70,,147.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,32,,67.58,percent of total billed charges,32% of total billed charges,84.48,239.01,
US ARTERIAL,28805146,CDM,921,RC,93923,HCPCS,OUTPATIENT,,,395.00,158.00,,,,,,other ,not seperately reimbursable,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,214.69,272,,,fee schedule,272% of BCBS fee schedule,214.69,272,,,fee schedule,272% of BCBS fee schedule,214.69,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,237,60,,189.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,276.5,70,,221.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,126.4,32,,101.12,percent of total billed charges,32% of total billed charges,126.4,335.75,
US GUIDED NEEDLE LOCALIZATION,28805147,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,505.00,202.00,,146.75,80,,,fee schedule,80% of Aetna fee schedule,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,303,60,,242.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,429.25,85,,343.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,353.5,70,,282.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,161.6,32,,129.28,percent of total billed charges,32% of total billed charges,33.51,429.25,
US TRANSRECTAL,28805150,CDM,402,RC,76872,HCPCS,OUTPATIENT,,,450.00,180.00,,98.29,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,139.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,137.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,98.29,382.5,
US DUPLEX UP EX LT ARTERIES UNILAT,28805543,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,450.00,180.00,,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,123.9,382.5,
US DUPLEX SCAN ART IN/OUT FLO ABD PELVI,28805544,CDM,921,RC,93975,HCPCS,OUTPATIENT,,,813.00,325.20,,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,454.57,272,,,fee schedule,272% of BCBS fee schedule,454.57,272,,,fee schedule,272% of BCBS fee schedule,454.57,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,487.8,60,,390.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,259.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,691.05,85,,552.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,569.1,70,,455.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,259.6,691.05,
FLUORO<60 MIN,28806459,CDM,320,RC,76000,HCPCS,OUTPATIENT,,,555.00,222.00,,38.58,80,,,fee schedule,80% of Aetna fee schedule,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,118.18,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,333,60,,266.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,33.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,471.75,85,,377.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,388.5,70,,310.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,177.6,32,,142.08,percent of total billed charges,32% of total billed charges,33.93,471.75,
US ABD COMPLETE,28809012,CDM,402,RC,76700,HCPCS,OUTPATIENT,,,450.00,180.00,,104.62,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,179.03,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,97.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,97.29,382.5,
*****US VENOUS DOPPLER(EXT)BIL,28811155,CDM,921,RC,93965,HCPCS,OUTPATIENT,,,518.00,207.20,,,,,,other ,not seperately reimbursable,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.8,60,,248.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,362.6,70,,290.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,165.76,32,,132.61,percent of total billed charges,32% of total billed charges,165.76,440.3,
US CAROTID DOPPLER,28811156,CDM,921,RC,93880,HCPCS,OUTPATIENT,,,501.00,200.40,,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,360.7,272,,,fee schedule,272% of BCBS fee schedule,360.7,272,,,fee schedule,272% of BCBS fee schedule,360.7,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,300.6,60,,240.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,188.09,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,350.7,70,,280.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,32,,128.26,percent of total billed charges,32% of total billed charges,160.32,425.85,
US ABI,28811160,CDM,921,RC,93922,HCPCS,OUTPATIENT,,,270.00,108.00,,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,113.86,272,,,fee schedule,272% of BCBS fee schedule,113.86,272,,,fee schedule,272% of BCBS fee schedule,113.86,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,162,60,,129.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,85.1,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,189,70,,151.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,86.4,32,,69.12,percent of total billed charges,32% of total billed charges,85.1,229.5,
US VENOUS DOPPLER UNILAT,28811166,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,296.00,118.40,,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,177.6,60,,142.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,207.2,70,,165.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,32,,75.78,percent of total billed charges,32% of total billed charges,94.72,268.14,
*US LOW EXT ART  LT DUP UNI,28814429,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,267.00,106.80,,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,160.2,60,,128.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,128.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,186.9,70,,149.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,32,,68.35,percent of total billed charges,32% of total billed charges,85.44,242.05,
US DUPLEX VEINS-UP LT EXT UNIL,28814431,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,390.00,156.00,,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,120.65,331.5,
US DUPLEX VEINS-LOW LT EXT UNIL,28814437,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,390.00,156.00,,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,268.14,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,234,60,,187.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,120.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,273,70,,218.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,124.8,32,,99.84,percent of total billed charges,32% of total billed charges,120.65,331.5,
US DUPLEXLT HEMODIALYSIS ACCESS LT,28814447,CDM,921,RC,93990,HCPCS,OUTPATIENT,,,600.00,240.00,,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,360,60,,288,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.32,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,420,70,,336,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,192,32,,153.6,percent of total billed charges,32% of total billed charges,192,32,,153.6,percent of total billed charges,32% of total billed charges,130.32,510,
US DUPLEX UP EXT ARTERIES UNI LT,28814448,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,360.00,144.00,,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,216,60,,172.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,252,70,,201.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,306,
US DUPLEX UP EXT ARTERIES UNI RT,28814449,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,360.00,144.00,,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,252.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,216,60,,172.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,123.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,252,70,,201.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,32,,92.16,percent of total billed charges,32% of total billed charges,115.2,306,
US BREAST LT LIMITED,28814567,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,378.00,151.20,,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,226.8,60,,181.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.39,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,264.6,70,,211.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,64.39,321.3,
US BREAST LT COMPLETE,28814568,CDM,402,RC,76641,HCPCS,OUTPATIENT,,,378.00,151.20,,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,96.04,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,226.8,60,,181.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,84.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,264.6,70,,211.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,120.96,32,,96.77,percent of total billed charges,32% of total billed charges,84.29,321.3,
US BREAST BIOPSY PERC LOC EACH ADD,28819084,CDM,360,RC,19084,HCPCS,OUTPATIENT,,,100.00,40.00,,3000,100,,,case rate,pays based on per visit rate,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,125,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,3000,
FOOT LEFT COMPLETE 3V,28873630,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,220.00,88.00,,23.78,80,,,fee schedule,80% of Aetna fee schedule,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,48.23,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,23.78,187,
US PREG UTERUS <14WK-0 EA ADD GEST,28876802,CDM,402,RC,76802,HCPCS,OUTPATIENT,,,100.00,40.00,,51.68,80,,,fee schedule,80% of Aetna fee schedule,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,190.75,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,25.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,25.99,190.75,
US OB PLACENTA  LOCATION,28876815,CDM,402,RC,76815,HCPCS,OUTPATIENT,,,142.00,56.80,,67.45,80,,,fee schedule,80% of Aetna fee schedule,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,85.2,60,,68.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,129.06,
US OB FETAL BIOPHYSICAL PROF,28876819,CDM,402,RC,76819,HCPCS,OUTPATIENT,,,160.00,64.00,,67.41,80,,,fee schedule,80% of Aetna fee schedule,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,57.08,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
US OB AMNIONIC FLUID INDEX,28878159,CDM,402,RC,76815,HCPCS,OUTPATIENT,,,450.00,180.00,,67.45,80,,,fee schedule,80% of Aetna fee schedule,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,129.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,61.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,61.95,382.5,
US LOW EXT RT ARTERIAL DUP-UNIL,28893926,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,450.00,180.00,,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,128.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,128.99,382.5,
US LOW EXT LT ARTERIAL DUP-UNIL,28893929,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,450.00,180.00,,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,242.05,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,128.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,128.99,382.5,
US SCREEN (AAA),28893930,CDM,402,RC,76706,HCPCS,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,98.91,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,255,
MYOCARDIAL STRAIN IMAGING,28893931,CDM,483,RC,93356,HCPCS,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,102,
ECHO BUBBLE STUDY,28893932,CDM,483,RC,93306,HCPCS,OUTPATIENT,,,1339.00,535.60,,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.4,60,,642.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,158.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,1138.15,85,,910.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,937.3,70,,749.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,428.48,32,,342.78,percent of total billed charges,32% of total billed charges,158.43,1138.15,
CERVICOCEREBRAL (ARCH),29000100,CDM,323,RC,75650,HCPCS,OUTPATIENT,,,1527.00,610.80,,132.58,80,,,fee schedule,80% of Aetna fee schedule,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,916.2,60,,732.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,1297.95,85,,1038.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,1068.9,70,,855.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,132.58,1297.95,
"VENOGRAPHY, CAVAL, SUPERIOR",29000101,CDM,323,RC,75827,HCPCS,OUTPATIENT,,,1526.00,610.40,,117.56,80,,,fee schedule,80% of Aetna fee schedule,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,915.6,60,,732.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.85,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1297.1,85,,1037.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1068.2,70,,854.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,81.85,1297.1,
"VENOGRAPHY, CAVAL, INFERIOR",29000102,CDM,323,RC,75825,HCPCS,OUTPATIENT,,,1526.00,610.40,,113.62,80,,,fee schedule,80% of Aetna fee schedule,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,915.6,60,,732.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,75.35,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1297.1,85,,1037.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1068.2,70,,854.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,75.35,1297.1,
"CAROTID, CERVICAL, BILATERAL",29000103,CDM,323,RC,75680,HCPCS,OUTPATIENT,,,1527.00,610.80,,165.79,80,,,fee schedule,80% of Aetna fee schedule,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,916.2,60,,732.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,1297.95,85,,1038.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,1068.9,70,,855.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,165.79,1297.95,
IVC FILTER PLACEMENT,29000104,CDM,323,RC,37191,HCPCS,OUTPATIENT,,,1526.00,610.40,,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,915.6,60,,732.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1907.5,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1297.1,85,,1037.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1068.2,70,,854.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,1907.5,
"RENAL W/FLUSH,AORTAGRAM BILAT",29000105,CDM,323,RC,36252,HCPCS,OUTPATIENT,,,1527.00,610.80,,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,916.2,60,,732.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1795.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,1297.95,85,,1038.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,1068.9,70,,855.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,32,,390.91,percent of total billed charges,32% of total billed charges,488.64,1795.34,
"AORTAGRAM, ABD W/RUNNER,ILIOFEM",29000107,CDM,323,RC,75630,HCPCS,OUTPATIENT,,,1594.00,637.60,,142.53,80,,,fee schedule,80% of Aetna fee schedule,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1190.22,272,,,fee schedule,272% of BCBS fee schedule,1190.22,272,,,fee schedule,272% of BCBS fee schedule,1190.22,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,956.4,60,,765.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.41,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1354.9,85,,1083.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,1115.8,70,,892.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,510.08,32,,408.06,percent of total billed charges,32% of total billed charges,79.41,1354.9,
CT ABD AORTA W/IF RUNOFF,29000108,CDM,352,RC,75635,HCPCS,OUTPATIENT,,,813.00,325.20,,873.37,100,,,case rate,pays based on per visit rate,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,487.8,60,,390.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,286.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,691.05,85,,552.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,569.1,70,,455.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,32,,208.13,percent of total billed charges,32% of total billed charges,260.16,873.37,
AV DIALYSIS SHUNT,29000109,CDM,323,RC,75791,HCPCS,OUTPATIENT,,,213.00,85.20,,170.4,80,,,fee schedule,80% of Aetna fee schedule,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.8,60,,102.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,149.1,70,,119.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,32,,54.53,percent of total billed charges,32% of total billed charges,68.16,181.05,
"AORTOGRAPHY, ADB",29075625,CDM,323,RC,75625,HCPCS,OUTPATIENT,,,1526.00,610.40,,118.74,80,,,fee schedule,80% of Aetna fee schedule,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,915.6,60,,732.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1297.1,85,,1037.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1068.2,70,,854.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,74.14,1297.1,
"AORTOGRAPHY, ABD + BILATERAL ILIOFEMORAL",29075630,CDM,323,RC,75625,HCPCS,OUTPATIENT,,,1862.00,744.80,,118.74,80,,,fee schedule,80% of Aetna fee schedule,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,1117.2,60,,893.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,74.14,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,1582.7,85,,1266.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,595.84,32,,476.67,percent of total billed charges,32% of total billed charges,74.14,1582.7,
"ANGIOGRAPHY,CAROTID,CEREBRAL,UNILATERAL",29075665,CDM,323,RC,75665,HCPCS,OUTPATIENT,,,1526.00,610.40,,152.33,80,,,fee schedule,80% of Aetna fee schedule,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,915.6,60,,732.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1297.1,85,,1037.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1068.2,70,,854.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,152.33,1297.1,
"ANGIOGRAPHY,SELECTIVE, EA ADD'L VESSEL",29075774,CDM,323,RC,75774,HCPCS,OUTPATIENT,,,1526.00,610.40,,75.15,80,,,fee schedule,80% of Aetna fee schedule,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,1141.56,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,915.6,60,,732.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,62.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1297.1,85,,1037.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,1068.2,70,,854.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,488.32,32,,390.66,percent of total billed charges,32% of total billed charges,62.76,1297.1,
C-PHEN DROPS,31000770,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
ADMINISTRATION OF PNEUMOCOCCAL VACCINE,31000771,CDM,771,RC,G0009,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
ADMINISTRATION OF INFLUENZA VACCINE,31000772,CDM,771,RC,G0008,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
ACTIFED TAB,31001002,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
diphenhydrAMINE 25 MG CAPSULE,31001003,CDM,636,RC,Q0163,HCPCS,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
diphenhydrAMINE 50 MG CAPSULE,31001004,CDM,636,RC,Q0163,HCPCS,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
ENTEX LA,31001005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LORATADINE 10 MG TABLET,31001006,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
GUAIFENESIN 1200MG OFF MARKET BAD#,31001007,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
guaiFENesin LA 600 MG TABLET,31001008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CETIRIZINE 10 MG TABLET,31001009,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MONTELUKAST 10 MG TABLET,31001010,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ZyrTEC SYRUP 10MG/10ML,31001011,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
LORATIDINE:5MG/5ML,31001012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ZYRTEC-D EQ TAB,31001013,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CLARITIN-D 12 HR 5/120:TAB,31001014,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DIMETAPP EXTENTABS,31001015,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PANMIST LA,31001016,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SINGULAIR 4MG TAB:4MG,31001017,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
NALDECON TABLET: EQ,31001018,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ALAVERT D12,31001021,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CYPROHEPTADINE TAB 4MG,31001022,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROMETHAZINE TAB 12.5MG,31001023,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PROMETHAZINE 25 MG TABLET,31001024,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PSEUDOEPHEDRINE 30MG TAB,31001027,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUDAFED 12 HOUR TAB:120MG,31001028,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUDAFED TABLET: 60MG,31001029,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
diphenhydrAMINE 50 MG/ML SDV,31001036,CDM,636,RC,J1200,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
PROMETHAZINE 25 MG/ML - SDV,31001037,CDM,636,RC,J2550,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
PHENERGAN INJ : 50MG/1ML,31001038,CDM,636,RC,J2550,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
ACTIFIED SYRUP : 1 OZ U-D EQUIV,31001039,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
PANNAZ TAB,31001040,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
GUAIFENESIN LA TABS 1200MG,31001042,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
guaiFENesin 100 MG/5 ML  4 0Z,31001043,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIMETANE DX: 10ML,31001045,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PERIACTIN SYRUP:PER OZ EQUIV,31001047,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
PROMETHEGAN 25 MG RECTAL SUPPOSITORY,31001060,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PHENERGAN SUPP : 50MG,31001061,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
PROMETHEGAN 12.5 MG RECTAL SUPPOSITORY,31001064,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TAVIST TAB:2.68 MG,31001078,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DIMETAPP ELIXIR:5 ML U/D,31001080,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SUDAFED LIQUID 5ML:5ML,31001081,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TAVIST D TAB,31001083,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LORATADINE 5 MG/5 ML SYRUP,31001090,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
diphenhydrAMINE 12.5 MG/5 ML - PER 1 ML,31001541,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
LEUKERAN TABLET:2MG,31002005,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MERCAPTOPURINE TAB:50MG,31002006,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
HYDREA CAP 500MG:500MG,31002007,CDM,636,RC,S0176,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
FLUOROURACIL EQ INJ:10ML,31002017,CDM,636,RC,J9190,HCPCS,OUTPATIENT,,,43.00,17.20,,1.34,80,,,fee schedule,80% of Aetna fee schedule,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,1.34,36.55,
ALBUMIN 12.5 GM/50 ML,31003001,CDM,636,RC,P9047,HCPCS,OUTPATIENT,,,760.00,304.00,,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456,60,,364.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,646,85,,516.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,532,70,,425.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,32,,194.56,percent of total billed charges,32% of total billed charges,243.2,646,
ALBUMIN 25 GM/100 ML,31003002,CDM,636,RC,P9047,HCPCS,OUTPATIENT,,,820.00,328.00,,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492,60,,393.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,697,85,,557.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,574,70,,459.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,32,,209.92,percent of total billed charges,32% of total billed charges,262.4,697,
IMMUNE SERUM GLOBULIN:2 ML,31003505,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
INDIGO CARMINE SOL 5 ML,31004003,CDM,250,RC,,,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
PREVNAR 13 VACCINE 0.5ML,31004010,CDM,636,RC,90670,HCPCS,OUTPATIENT,,,235.00,94.00,,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141,60,,112.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,199.75,85,,159.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,164.5,70,,131.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,32,,60.16,percent of total billed charges,32% of total billed charges,75.2,199.75,
HEPATITIS B VACCINE-1 ML,31004011,CDM,636,RC,90744,HCPCS,OUTPATIENT,,,242.00,96.80,,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.2,60,,116.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,169.4,70,,135.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,32,,61.95,percent of total billed charges,32% of total billed charges,77.44,205.7,
INFLUENZA VACCINE:1ML,31004012,CDM,250,RC,Q2038,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
HEPATITIS A VACCINE-1 ML,31004014,CDM,250,RC,90632,HCPCS,OUTPATIENT,,,145.00,58.00,,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87,60,,69.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,101.5,70,,81.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,123.25,
PNEUMOVAX 23 VACCINE 0.5ML,31004015,CDM,636,RC,90732,HCPCS,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,127.5,
TUBERCULIN PPD TEST,31004016,CDM,300,RC,86580,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.8,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
HISTOPLASMIN SKIN TEST,31004017,CDM,300,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
MUMPS SKIN TEST,31004018,CDM,300,RC,,,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
CANDIDA SKIN TEST,31004019,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
MULTITEST CMI PANEL,31004020,CDM,254,RC,,,OUTPATIENT,,,159.00,63.60,,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.4,60,,76.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,111.3,70,,89.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,135.15,
TRICHOPHYTON SKIN TEST:0.2ML,31004021,CDM,300,RC,,,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,96.05,
FLUORESCITE INJ 10%:5 ML,31004023,CDM,250,RC,,,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
CORTROSYN 0.25MG VIAL,31004027,CDM,636,RC,J0834,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
KINEVAC (CCK) 5MCG SDV,31004028,CDM,636,RC,J2805,HCPCS,OUTPATIENT,,,160.00,64.00,,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
FLUZONE ADULT VACCINE 2013-2014,31004050,CDM,636,RC,90656,HCPCS,OUTPATIENT,,,31.00,12.40,,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.6,60,,14.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,26.35,
FLUARIX QUADRIVALENT VACCINE 2020-21,31004051,CDM,636,RC,,,OUTPATIENT,,,31.10,12.44,,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.66,60,,14.93,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,26.44,85,,21.15,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,21.77,70,,17.42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,26.44,
FLUZONE TRIVALENT VACCINE 2014-2015,31004052,CDM,636,RC,,,OUTPATIENT,,,31.10,12.44,,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.66,60,,14.93,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,26.44,85,,21.15,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,21.77,70,,17.42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,26.44,
FLUZONE PED VACCINE 2013-14,31004060,CDM,636,RC,90655,HCPCS,OUTPATIENT,,,31.00,12.40,,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.6,60,,14.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,21.7,70,,17.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,32,,7.94,percent of total billed charges,32% of total billed charges,9.92,26.35,
FLUZONE >65YO VACCINE 2016-17 HI DOSE,31004070,CDM,636,RC,90656,HCPCS,OUTPATIENT,,,31.10,12.44,,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.66,60,,14.93,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,26.44,85,,21.15,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,21.77,70,,17.42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,32,,7.96,percent of total billed charges,32% of total billed charges,9.95,26.44,
PEDIARX 0.5ML VACCINE:0.5ML,31004075,CDM,636,RC,90744,HCPCS,OUTPATIENT,,,138.00,55.20,,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,60,,66.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,96.6,70,,77.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,32,,35.33,percent of total billed charges,32% of total billed charges,44.16,117.3,
SPIRONOLACTONE 25 MG TABLET,31005001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ALDACTAZIDE TABS,31005002,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SPIRONOLACTONE 50 MG TABLET,31005003,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BENEMID TAB:500 MG EQUIV,31005004,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
EPLERENONE TAB 25MG,31005005,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
COLBENEMID TAB EQUIV,31005006,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NEPTAZANE TABLET: 50MG,31005007,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ACETAZOLAMIDE 500MG IV:500MG,31005008,CDM,636,RC,J1120,HCPCS,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
ACETAZOLAMIDE TB 250MG,31005009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIAMOX SEQUELS:500 MG,31005011,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TRIAMTERENE/HCTZ 37.5 MG - 25 MG TAB,31005012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
metOLazone 2.5 MG TABLET,31005014,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METOLAZONE TAB 5MG:5MG,31005015,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CHLORTHALIDONE TAB 25MG:25MG,31005016,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
FUROSEMIDE 10MG/ML LIQ:1ML,31005017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FUROSEMIDE TAB 80MG,31005019,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FUROSEMIDE 20 MG TABLET,31005020,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FUROSEMIDE 40 MG TABLET,31005021,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ETHACRYNATE SOD IV: 50MG,31005022,CDM,250,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
DEMADEX:20MG/2ML AMP,31005023,CDM,636,RC,J3265,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
DEMADEX:50MG/5ML AMP,31005024,CDM,636,RC,J3265,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
EDECRIN 25MG TAB:25MG,31005025,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DEMADEX TAB:20MG,31005026,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SODIUM CHLORIDE ENSEALS:1GM EQ,31005029,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
THERMOTABS 450MG:450MG,31005030,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SODIUM CHLORIDE 1 GM TABLET,31005031,CDM,250,RC,,,OUTPATIENT,,,5.10,2.04,,,,,,other ,not seperately reimbursable,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.06,60,,2.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,4.34,85,,3.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,3.57,70,,2.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,1.63,32,,1.3,percent of total billed charges,32% of total billed charges,1.63,4.34,
hydroCHLOROthiazide 12.5 MG CAPSULE,31005034,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
hydroCHLOROthiazide 25 MG TABLET,31005035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HYDRODIURIL TAB: 50MG EQ,31005036,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FUROSEMIDE 20 MG/2 ML SDV,31005037,CDM,636,RC,J1940,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
VERAPAMIL ER 180MG TAB:180MG,31005039,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
POTASSIUM CHLORIDE 20 MEQ POWDER,31005045,CDM,250,RC,,,OUTPATIENT,,,16.55,6.62,,,,,,other ,not seperately reimbursable,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.93,60,,7.94,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,14.07,85,,11.26,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,11.59,70,,9.27,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,5.3,32,,4.24,percent of total billed charges,32% of total billed charges,5.3,14.07,
K-LYTE TAB:EQUIV,31005047,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MANNITOL SDV 25%:50ML,31005048,CDM,636,RC,J2150,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
MANNITOL IVPB 20% 500ML: 500ML,31005049,CDM,636,RC,J2150,HCPCS,OUTPATIENT,,,208.00,83.20,,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,60,,99.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,145.6,70,,116.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,176.8,
SODIUM POLYSTYRENE SULFONATE 15 GM/60 ML,31005059,CDM,250,RC,,,OUTPATIENT,,,27.03,10.81,,,,,,other ,not seperately reimbursable,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.22,60,,12.98,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,22.98,85,,18.38,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,18.92,70,,15.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,8.65,32,,6.92,percent of total billed charges,32% of total billed charges,8.65,22.98,
RENAGEL 800MG TAB:800MG,31005060,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
RENAGEL 400MG TB:400MG,31005061,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SODIUM BICARBONATE 8.4% - 50 ML SYRINGE,31005062,CDM,250,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
SOD BICARB INJ 8.4%:10MLP-F,31005063,CDM,250,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
D50W - 50 ML PREFILLED SYRINGE,31005064,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
GLUTOSE15 GEL - 37.5 GM TUBE,31005065,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
TRACE ELEMENTS-4 1ML,31005078,CDM,250,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
TPN ELECTROLYTES SDV 20ML:20ML,31005079,CDM,250,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
PHARM CONSULT,31005080,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
PHARM CONSULT-TPN,31005081,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
DEXTROSE 30% 1000ML:D30W 1000ML,31005083,CDM,250,RC,,,OUTPATIENT,,,145.00,58.00,,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87,60,,69.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,101.5,70,,81.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,123.25,
FUROSEMIDE 100 MG/10 ML SDV,31005084,CDM,636,RC,J1940,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
KLOR-CON 20 MEQ TABLET,31005085,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TPN(D50W/AA8.5%)1000ML:1000ML,31005086,CDM,250,RC,,,OUTPATIENT,,,145.00,58.00,,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87,60,,69.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,101.5,70,,81.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,123.25,
PROCALAMINE 3% 1000ML,31005087,CDM,258,RC,,,OUTPATIENT,,,208.00,83.20,,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,60,,99.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,145.6,70,,116.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,32,,53.25,percent of total billed charges,32% of total billed charges,66.56,176.8,
TPN(D30W/AA8.5%)1000ML:1000ML,31005088,CDM,250,RC,,,OUTPATIENT,,,145.00,58.00,,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87,60,,69.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,101.5,70,,81.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,123.25,
TRACE ELEMENTS-5 1ML,31005089,CDM,250,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
KCL 20MEQ/10ML SDV,31005090,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
KCL 10MEQ/5ML SDV,31005091,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
KCL 40MEQ/20ML SDV,31005092,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
KCL 10 MEQ/100 ML - PREMIXED BAG,31005093,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
KCL 30MEQ/15ML SDV,31005094,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
POTASSIUM CL ORAL LIQ 40MEQ (N/A),31005095,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
POTASSIUM CL ORAL LIQ 20MEQ/15ML (N/A),31005097,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
K ACETATE 2MEQ/ML 20ML,31005098,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
NA ACETATE 4MEQ/ML 50MLS,31005099,CDM,250,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
K ACETATE 4MEQ/ML 50ML,31005100,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
HETASTARCH 6%/NS 500 ML PREMIXED BAG,31005101,CDM,250,RC,,,OUTPATIENT,,,366.00,146.40,,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.6,60,,175.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,311.1,85,,248.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,256.2,70,,204.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,32,,93.7,percent of total billed charges,32% of total billed charges,117.12,311.1,
BCG VIAL,31005102,CDM,250,RC,,,OUTPATIENT,,,499.00,199.60,,,,,,other ,not seperately reimbursable,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.4,60,,239.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,424.15,85,,339.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,349.3,70,,279.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,159.68,32,,127.74,percent of total billed charges,32% of total billed charges,159.68,424.15,
KCL 20MEQ/100ML BOLUS,31005103,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
KLOR-CON 40MEQ DOSE,31005104,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SLOW-K TAB:600MG/8MEQ EQ,31005105,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SODIUM BICARBONATE 8.4% - 50 ML SDV,31005106,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
FUROSEMIDE 40 MG/4 ML SDV,31005108,CDM,636,RC,J1940,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
NA PHOSPHATE 3mM/ML:15ML VIAL,31005110,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
K PHOSPHATE 3mM/ML 5ML,31005111,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
NACL SDV 4MEQ/ML 100ML,31005112,CDM,250,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
DYRENIUM CAP:50MG,31005114,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NA ACETATE 2MEQ/ML 50MLS,31005116,CDM,250,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
NACL 2.5MEQ/ML SDV:40ml,31005120,CDM,636,RC,J7131,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
KCL 10MEQ CAP:USE #31031099,31005122,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ENDURONYL TAB,31005131,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SOD BICARB INJ 4.2%:INF 10ML P,31005138,CDM,250,RC,,,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
MICRO-K TAB:8 MEQ EQ,31005139,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ADENOSINE 6 MG/2 ML SDV,31005141,CDM,636,RC,J0153,HCPCS,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
ADENOSINE 12MG/4ML SYRINGE,31005142,CDM,636,RC,J0153,HCPCS,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
INDAPAMIDE 2.5MG:2.5MG,31005143,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
BUMETANIDE 1 MG TABLET,31005164,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
THERMOTABS 904MG:904MG,31005172,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PAPAIN/UREA/CHLRPHYL OINT:30GM,31006015,CDM,250,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
REGRANEX GEL 0.01% 15GM:15GM,31006016,CDM,250,RC,,,OUTPATIENT,,,1198.00,479.20,,,,,,other ,not seperately reimbursable,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,718.8,60,,575.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,1018.3,85,,814.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,838.6,70,,670.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,383.36,32,,306.69,percent of total billed charges,32% of total billed charges,383.36,1018.3,
ACCUZYME OINTMENT 30GM:30GM,31006017,CDM,250,RC,,,OUTPATIENT,,,174.00,69.60,,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,147.9,
COLLAGENASE-SANTYL OINT 15GM,31006018,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
ELASE OINT:10 GM,31006019,CDM,250,RC,,,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
ELASE- CHLORO OINT:10 GM,31006021,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
"STREPTOKINASE IV:250,000 UNITS",31006038,CDM,636,RC,J2995,HCPCS,OUTPATIENT,,,682.00,272.80,,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.2,60,,327.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,579.7,85,,463.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,477.4,70,,381.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,32,,174.59,percent of total billed charges,32% of total billed charges,218.24,579.7,
ACTIVASE TPA VIAL 100 MG,31006039,CDM,636,RC,J2997,HCPCS,OUTPATIENT,,,20037.00,8014.80,,87.43,100,,,fee schedule,100% of Aetna fee schedule,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12022.2,60,,9617.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,17031.45,85,,13625.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,14025.9,70,,11220.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,6411.84,32,,5129.47,percent of total billed charges,32% of total billed charges,87.43,17031.45,
RETAVASE IV: 20MG,31006040,CDM,636,RC,J2993,HCPCS,OUTPATIENT,,,8997.00,3598.80,,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5398.2,60,,4318.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,7647.45,85,,6117.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,6297.9,70,,5038.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,2879.04,7647.45,
TNKase 50 MG KIT,31006041,CDM,636,RC,J3101,HCPCS,OUTPATIENT,,,8997.00,3598.80,,129.27,100,,,fee schedule,100% of Aetna fee schedule,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5398.2,60,,4318.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,7647.45,85,,6117.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,6297.9,70,,5038.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,2879.04,32,,2303.23,percent of total billed charges,32% of total billed charges,129.27,7647.45,
CATHFLO TPA 2MG VIAL,31006042,CDM,636,RC,J2997,HCPCS,OUTPATIENT,,,365.00,146.00,,87.43,100,,,fee schedule,100% of Aetna fee schedule,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219,60,,175.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,255.5,70,,204.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,87.43,310.25,
REOPRO 10MG/2ML:10MG,31006043,CDM,636,RC,J0130,HCPCS,OUTPATIENT,,,1617.00,646.80,,,,,,other ,not seperately reimbursable,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,970.2,60,,776.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,1374.45,85,,1099.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,1131.9,70,,905.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,517.44,32,,413.95,percent of total billed charges,32% of total billed charges,517.44,1374.45,
INTEGRILIN 20MG/ML SDV:20MG,31006044,CDM,636,RC,J1327,HCPCS,OUTPATIENT,,,361.00,144.40,,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.6,60,,173.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,252.7,70,,202.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,32,,92.42,percent of total billed charges,32% of total billed charges,115.52,306.85,
INTEGRILIN 75MG/100ML IVPB:75MG,31006045,CDM,636,RC,J1327,HCPCS,OUTPATIENT,,,1082.00,432.80,,,,,,other ,not seperately reimbursable,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,649.2,60,,519.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,919.7,85,,735.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,757.4,70,,605.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,346.24,32,,276.99,percent of total billed charges,32% of total billed charges,346.24,919.7,
INTEGRILIN 200MG/100ML IVPB:200MG,31006046,CDM,636,RC,J1327,HCPCS,OUTPATIENT,,,1950.00,780.00,,,,,,other ,not seperately reimbursable,624,32,,499.2,percent of total billed charges,32% of total billed charges,624,32,,499.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1170,60,,936,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624,32,,499.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624,32,,499.2,percent of total billed charges,32% of total billed charges,1657.5,85,,1326,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624,32,,499.2,percent of total billed charges,32% of total billed charges,624,32,,499.2,percent of total billed charges,32% of total billed charges,1365,70,,1092,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,624,32,,499.2,percent of total billed charges,32% of total billed charges,624,32,,499.2,percent of total billed charges,32% of total billed charges,624,1657.5,
TRUSOPT 2% 10ML,31006118,CDM,250,RC,,,OUTPATIENT,,,171.00,68.40,,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.6,60,,82.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,119.7,70,,95.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,145.35,
CARDEC-DM EQ DROPS BOTTLE:30ML,31007045,CDM,251,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
PEDIACARE DROPS 15ML:15ML,31007046,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
CARDEC DROPS:30ML,31007047,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
CARDEC-DM EQ DROPS 1ML DOSE,31007048,CDM,251,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
CARDEC DM EQ SYRUP 5ML:5ML,31007049,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
RONDEC SYRUP 5ML:5ML,31007050,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
BROMHIST-PDX DROPS 30ML:30ML,31007051,CDM,251,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
BENZONATATE 100 MG CAPSULE,31007054,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HYDROcodone/HOMATROPINE 5 MG-1.5 MG/5 ML,31007059,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
GUAIFENESIN 300MG/15ML:15ML,31007060,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GUAIFENESIN 100MG/5ML,31007061,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
guaiFENesin 200 MG/10 ML UD,31007062,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BENZONATATE 200MG CAP,31007064,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ROBITUSSIN AC 200-20 MG/10 ML CUP,31007065,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VICODIN TUSS 5ML:5ML,31007066,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PANCOF XP 5ML:5ML,31007067,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PROLEX-DH 10ML:10ML,31007068,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
TUSSIONEX EQ SUSP 5ML DOSE,31007069,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PROMETH 6.25MG/5ML SYRUP : 5ML,31007523,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PROMETH & CODEINE:20MG/10ML E,31007524,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DELSYM 30MG/5ML:5ML,31007545,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
guaiFENesin - DM 10 ML UNIT DOSE CUP,31007546,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
BROMFED DM 5ML DOSE,31007560,CDM,251,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
guaiFENesin - DM 10 ML (BULK),31007562,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PROMETHAZINE W/CODEINE 5 ML,31007648,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ANTIVENIN BLACK WIDOW,31009001,CDM,250,RC,,,OUTPATIENT,,,168.00,67.20,,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,60,,80.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,117.6,70,,94.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,32,,43.01,percent of total billed charges,32% of total billed charges,53.76,142.8,
ANTIVENIN CORAL SNAKE,31009002,CDM,250,RC,,,OUTPATIENT,,,1314.00,525.60,,,,,,other ,not seperately reimbursable,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,788.4,60,,630.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,525.6,40,,420.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,1116.9,85,,893.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,919.8,70,,735.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,420.48,32,,336.38,percent of total billed charges,32% of total billed charges,420.48,1116.9,
ANTIVENIN POLYVALENT (RATTLESNAKE),31009003,CDM,250,RC,,,OUTPATIENT,,,912.00,364.80,,,,,,other ,not seperately reimbursable,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,547.2,60,,437.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,364.8,40,,291.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,775.2,85,,620.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,638.4,70,,510.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,291.84,32,,233.47,percent of total billed charges,32% of total billed charges,291.84,775.2,
TETANUS IMMUNE GLOBULIN 250 UNITS:250 UN,31009004,CDM,636,RC,J1670,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
TET-TOXOID:0.5 ML,31009005,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
HEPATITIS B IMMUNE GLOB:5ml,31009006,CDM,250,RC,,,OUTPATIENT,,,1177.50,471.00,,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706.5,60,,565.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,1000.88,85,,800.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,824.25,70,,659.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,1000.88,
PANGLOBULIN IV 6GM:6GM,31009007,CDM,636,RC,,,OUTPATIENT,,,883.00,353.20,,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,529.8,60,,423.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,750.55,85,,600.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,618.1,70,,494.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,750.55,
TENIVAC - 0.5 ML SYRINGE,31009008,CDM,636,RC,90714,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
POLYGAM:5D 10GM,31009009,CDM,636,RC,J1566,HCPCS,OUTPATIENT,,,450.00,180.00,,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270,60,,216,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,315,70,,252,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,32,,115.2,percent of total billed charges,32% of total billed charges,144,382.5,
DIGIFAB 40MG SDV:40MG,31009010,CDM,636,RC,J1162,HCPCS,OUTPATIENT,,,2022.00,808.80,,3969.27,100,,,fee schedule,100% of Aetna fee schedule,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1213.2,60,,970.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,1718.7,85,,1374.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,1415.4,70,,1132.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,647.04,32,,517.63,percent of total billed charges,32% of total billed charges,647.04,3969.27,
RABIES VACCINE,31009011,CDM,636,RC,90675,HCPCS,OUTPATIENT,,,317.25,126.90,,,,,,other ,not seperately reimbursable,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.35,60,,152.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,269.66,85,,215.73,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,222.08,70,,177.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,101.52,32,,81.22,percent of total billed charges,32% of total billed charges,101.52,269.66,
GAMUNEX 1GM/10ML:1GM,31009012,CDM,636,RC,J1561,HCPCS,OUTPATIENT,,,206.00,82.40,,43.67,100,,,fee schedule,100% of Aetna fee schedule,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.6,60,,98.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,144.2,70,,115.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,65.92,32,,52.74,percent of total billed charges,32% of total billed charges,43.67,175.1,
IV IMMUNE GLOBULIN 5GM:5GM(BAD #),31009013,CDM,636,RC,,,OUTPATIENT,,,1014.00,405.60,,,,,,other ,not seperately reimbursable,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,608.4,60,,486.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,861.9,85,,689.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,709.8,70,,567.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,324.48,32,,259.58,percent of total billed charges,32% of total billed charges,324.48,861.9,
GAMMAGARD 10GM:10GM,31009014,CDM,636,RC,J1569,HCPCS,OUTPATIENT,,,2026.00,810.40,,43.63,100,,,fee schedule,100% of Aetna fee schedule,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1215.6,60,,972.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,1722.1,85,,1377.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,1418.2,70,,1134.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,648.32,32,,518.66,percent of total billed charges,32% of total billed charges,43.63,1722.1,
HIV PEP BASIC KIT:BASIC KIT,31009015,CDM,250,RC,,,OUTPATIENT,,,384.00,153.60,,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,60,,184.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,326.4,85,,261.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,268.8,70,,215.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,326.4,
HIV PEP EXPANDED KIT:EXPANDED,31009016,CDM,250,RC,,,OUTPATIENT,,,714.00,285.60,,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.4,60,,342.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,606.9,85,,485.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,499.8,70,,399.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,606.9,
CROFAB 1GM IV:1GM,31009017,CDM,636,RC,J0840,HCPCS,OUTPATIENT,,,3800.00,1520.00,,2908.21,100,,,fee schedule,100% of Aetna fee schedule,1216,32,,972.8,percent of total billed charges,32% of total billed charges,1216,32,,972.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2280,60,,1824,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1216,32,,972.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1216,32,,972.8,percent of total billed charges,32% of total billed charges,3230,85,,2584,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1216,32,,972.8,percent of total billed charges,32% of total billed charges,1216,32,,972.8,percent of total billed charges,32% of total billed charges,2660,70,,2128,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1216,32,,972.8,percent of total billed charges,32% of total billed charges,1216,32,,972.8,percent of total billed charges,32% of total billed charges,1216,3230,
DIPH-TET PED,31009018,CDM,636,RC,90714,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
PANGLOBULIN IV 12GM:12GM,31009019,CDM,636,RC,,,OUTPATIENT,,,1765.00,706.00,,,,,,other ,not seperately reimbursable,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1059,60,,847.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,1500.25,85,,1200.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,1235.5,70,,988.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,564.8,32,,451.84,percent of total billed charges,32% of total billed charges,564.8,1500.25,
HEPATITIS B IMMUNE GLOBULIN 5ML:5ML,31009020,CDM,636,RC,J1670,HCPCS,OUTPATIENT,,,1177.50,471.00,,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706.5,60,,565.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,1000.88,85,,800.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,824.25,70,,659.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,1000.88,
RHOGAM 300 MCG - PREFILLED SYRINGE,31009021,CDM,636,RC,J2790,HCPCS,OUTPATIENT,,,611.00,244.40,,,,,,other ,not seperately reimbursable,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.6,60,,293.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,519.35,85,,415.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,427.7,70,,342.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,195.52,32,,156.42,percent of total billed charges,32% of total billed charges,195.52,519.35,
CARIMUNE 6GM IV:6GM,31009022,CDM,636,RC,,,OUTPATIENT,,,883.00,353.20,,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,529.8,60,,423.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,750.55,85,,600.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,618.1,70,,494.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,750.55,
CYCLOSPORINE 25MG CAP:25MG,31009023,CDM,250,RC,J7515,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CYCLOSPORINE (MOD) 100MG :100MG,31009024,CDM,250,RC,J7515,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
RUBELLA(MERUVAX) VACCINE:1ML,31009025,CDM,250,RC,,,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
MEASLES/MUMPS/RUBELLA VACCINE:MMR,31009026,CDM,636,RC,90707,HCPCS,OUTPATIENT,,,227.00,90.80,,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.2,60,,108.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,158.9,70,,127.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,192.95,
RABIES IMMUNE GLOBULIN 300 U/2 ML,31009027,CDM,636,RC,90375,HCPCS,OUTPATIENT,,,1010.00,404.00,,,,,,other ,not seperately reimbursable,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,606,60,,484.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,858.5,85,,686.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,707,70,,565.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,323.2,32,,258.56,percent of total billed charges,32% of total billed charges,323.2,858.5,
GAMUNEX 10% (5GM/50ML):5GM,31009028,CDM,636,RC,J1561,HCPCS,OUTPATIENT,,,713.00,285.20,,43.67,100,,,fee schedule,100% of Aetna fee schedule,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.8,60,,342.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,499.1,70,,399.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,228.16,32,,182.53,percent of total billed charges,32% of total billed charges,43.67,606.05,
GAMUNEX 10% (10GM/100ML):10GM,31009029,CDM,636,RC,J1561,HCPCS,OUTPATIENT,,,1425.00,570.00,,43.67,100,,,fee schedule,100% of Aetna fee schedule,456,32,,364.8,percent of total billed charges,32% of total billed charges,456,32,,364.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,855,60,,684,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456,32,,364.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456,32,,364.8,percent of total billed charges,32% of total billed charges,1211.25,85,,969,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456,32,,364.8,percent of total billed charges,32% of total billed charges,456,32,,364.8,percent of total billed charges,32% of total billed charges,997.5,70,,798,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,456,32,,364.8,percent of total billed charges,32% of total billed charges,456,32,,364.8,percent of total billed charges,32% of total billed charges,43.67,1211.25,
**GAMUNEX 10%(20GM/200ML):20GM,31009030,CDM,636,RC,J1561,HCPCS,OUTPATIENT,,,2849.00,1139.60,,43.67,100,,,fee schedule,100% of Aetna fee schedule,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1709.4,60,,1367.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,2421.65,85,,1937.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,1994.3,70,,1595.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,43.67,2421.65,
FLEBOGAMMA 5% 5GM/100ML,31009031,CDM,636,RC,J1572,HCPCS,OUTPATIENT,,,34.94,13.98,,36.86,100,,,fee schedule,100% of Aetna fee schedule,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.96,60,,16.77,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,29.7,85,,23.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,24.46,70,,19.57,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,36.86,
FLEBOGAMMA 5% 10GM/200ML,31009032,CDM,636,RC,J1572,HCPCS,OUTPATIENT,,,34.94,13.98,,36.86,100,,,fee schedule,100% of Aetna fee schedule,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.96,60,,16.77,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,29.7,85,,23.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,24.46,70,,19.57,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,36.86,
FLEBOGAMMA 500MG:500MG,31009033,CDM,636,RC,J1572,HCPCS,OUTPATIENT,,,63.00,25.20,,36.86,100,,,fee schedule,100% of Aetna fee schedule,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
CROFAB/NS 250ML INFUSION,31009034,CDM,636,RC,J1561,HCPCS,OUTPATIENT,,,2849.00,1139.60,,43.67,100,,,fee schedule,100% of Aetna fee schedule,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1709.4,60,,1367.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,2421.65,85,,1937.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,1994.3,70,,1595.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,911.68,32,,729.34,percent of total billed charges,32% of total billed charges,43.67,2421.65,
"RABIES IMMUNE GLOBULIN 1,500 U/10 ML",31009035,CDM,636,RC,90375,HCPCS,OUTPATIENT,,,5300.00,2120.00,,,,,,other ,not seperately reimbursable,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3180,60,,2544,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,4505,85,,3604,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,3710,70,,2968,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,1696,32,,1356.8,percent of total billed charges,32% of total billed charges,1696,4505,
TETANUS-DIPH TOXOID 0.5ML SDV:0.5ML <7YO,31009036,CDM,250,RC,90702,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
FLEBOGAMMA 5% 500MG,31009037,CDM,636,RC,J1572,HCPCS,OUTPATIENT,,,34.94,13.98,,36.86,100,,,fee schedule,100% of Aetna fee schedule,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.96,60,,16.77,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,29.7,85,,23.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,24.46,70,,19.57,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,32,,8.94,percent of total billed charges,32% of total billed charges,11.18,36.86,
MICRHOGAM 50MCG: 50MCG SYR,31009050,CDM,636,RC,J2788,HCPCS,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
NEGGRAM TABLET: 500MG,31010002,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PHENAZOPYRIDINE 200MG,31010007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CLARITIN REDITABS: 10 MG,31010010,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
PHENAZOPYRIDINE 100 MG TABLET,31010011,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TAMIFLU 75 MG CAPSULE,31010012,CDM,250,RC,G9035,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
URISED TAB,31010013,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FUROXONE SUSP:5 ML,31010014,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
AMANTADINE 100MG CAP:100MG,31010015,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AMANTADINE 100MG/10ML SY:10ML,31010016,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TAMIFLU 6MG/ML:60ML BOTTLE,31010017,CDM,250,RC,,,OUTPATIENT,,,186.50,74.60,,,,,,other ,not seperately reimbursable,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.9,60,,89.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,158.53,85,,126.82,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,130.55,70,,104.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,59.68,32,,47.74,percent of total billed charges,32% of total billed charges,59.68,158.53,
TAMIFLU 6MG/ML 1ML DOSE,31010018,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
CLINDAMYCIN 150 MG CAPSULE,31010019,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TAMIFLU 30 MG CAPSULE,31010020,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
ANCOBON CAP 500MG:500MG,31010024,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
NEOMYCIN 500 MG TABLET,31010025,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FLUCONAZOLE 100 MG TABLET,31010026,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DIFLUCAN 200/100ML IV:200MG (BRAND NAME),31010027,CDM,636,RC,J1450,HCPCS,OUTPATIENT,,,552.00,220.80,,,,,,other ,not seperately reimbursable,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,331.2,60,,264.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,469.2,85,,375.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,386.4,70,,309.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,176.64,32,,141.31,percent of total billed charges,32% of total billed charges,176.64,469.2,
AMPHOTERICIN-B 50MG SDV:50MG,31010028,CDM,250,RC,J0285,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
FLUCONAZOLE 40MG/ML ORAL SUSP:35ML,31010029,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
DIFLUCAN SUSP 10MG/ML:10MG/ML,31010030,CDM,250,RC,,,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,115.6,
DIFLUCAN 400MG/200ML:400MG,31010031,CDM,636,RC,J1450,HCPCS,OUTPATIENT,,,692.00,276.80,,,,,,other ,not seperately reimbursable,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,415.2,60,,332.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,588.2,85,,470.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,484.4,70,,387.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,221.44,32,,177.15,percent of total billed charges,32% of total billed charges,221.44,588.2,
FLUCONAZOLE TAB 150MG dose n/a,31010032,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
VFEND 200MG/10ML SDV:200MG,31010033,CDM,636,RC,J3465,HCPCS,OUTPATIENT,,,512.00,204.80,,,,,,other ,not seperately reimbursable,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.2,60,,245.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,435.2,85,,348.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,358.4,70,,286.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,163.84,32,,131.07,percent of total billed charges,32% of total billed charges,163.84,435.2,
FLUCONAZOLE 200 MG/NS 100 ML - PREMIXED,31010034,CDM,636,RC,J1450,HCPCS,OUTPATIENT,,,287.00,114.80,,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.2,60,,137.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,200.9,70,,160.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,243.95,
AMBISOME SDV:50MG,31010035,CDM,636,RC,J0289,HCPCS,OUTPATIENT,,,534.00,213.60,,,,,,other ,not seperately reimbursable,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320.4,60,,256.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,373.8,70,,299.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,170.88,32,,136.7,percent of total billed charges,32% of total billed charges,170.88,453.9,
GRISEOFULVIN ORAL SUSP 125MG/5ML:5ML,31010036,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
FLUCONAZOLE IVPB 100MG/50ML:100MG,31010037,CDM,636,RC,J1450,HCPCS,OUTPATIENT,,,287.00,114.80,,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.2,60,,137.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,200.9,70,,160.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,32,,73.47,percent of total billed charges,32% of total billed charges,91.84,243.95,
ERYTHROCIN FTAB:250 MG,31010039,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GENTAMICIN PED SDV:20MG/2ML,31010040,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
GENTAMICIN 80MG/2ML SDV,31010041,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
GENTAMICIN IVPB 400MG/NS 100ML,31010042,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
GENT 400MG/CLINDA 900MG/NS 100ML,31010043,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
NITROFURANTOIN CAP 50MG:50MG,31010045,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NITROFURANTOIN MONO/MACRO 100 MG CAPSULE,31010046,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GENTAMICIN 80MG/50ML PM IVPB,31010047,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,117.00,46.80,,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.2,60,,56.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,81.9,70,,65.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,99.45,
GENTAMICIN 80MG/2ML SDV IM ONLY:IM ONLY,31010049,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
SOTRADECOL 1% 2ML SDV:2ML,31010050,CDM,250,RC,,,OUTPATIENT,,,158.00,63.20,,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.8,60,,75.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,110.6,70,,88.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,32,,40.45,percent of total billed charges,32% of total billed charges,50.56,134.3,
METHYLENE BLUE INJ 1%:1ML,31010051,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
BENZOIN TINCTURE - 60 ML BOTTLE,31010052,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
GASTROVIEW 66-10%:120ML,31010053,CDM,255,RC,,,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
MONSEL'S SOLUTION 30ML:30ML,31010054,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
LUGOLS 5% SOLUTION 30ML:30ML,31010055,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
ACETIC ACID 3% 30ML:30ML,31010056,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
MASTISOL ADHESIVE 0.66ML,31010057,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
BENADRYL 1% CREAM - 30 GM TUBE,31010061,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
ZONALON 5% CR:30GMM,31010062,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
ELIDEL 1% CREAM 30GM:30GM,31010063,CDM,250,RC,,,OUTPATIENT,,,159.00,63.60,,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.4,60,,76.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,111.3,70,,89.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,135.15,
CLEOCIN SUSP 15MG/ML:100ML,31010066,CDM,250,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
CLINDAMYCIN 900 MG/6 ML SDV,31010067,CDM,250,RC,J0736,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
CHLOROMYCETIN INJ:1 GM,31010068,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
CLINDAMYCIN 300 MG/2 ML SDV,31010069,CDM,250,RC,J0736,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CLINDAMYCIN 600 MG/4 ML SDV,31010070,CDM,250,RC,J0736,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
CLEOCIN 900MG/50ML PREMIX,31010071,CDM,250,RC,,,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,147.05,
CLEOCIN 600MG/D5W 50ML PREMIX,31010072,CDM,250,RC,,,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,147.05,
VANCOMYCIN CAP 250MG,31010073,CDM,250,RC,,,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
TOBRAMYCIN 80MG/2ML SDV,31010074,CDM,636,RC,J3260,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
VANCOMYCIN 500 MG VIAL,31010075,CDM,636,RC,J3370,HCPCS,OUTPATIENT,,,141.00,56.40,,2.61,100,,,fee schedule,100% of Aetna fee schedule,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,2.61,119.85,
VANCOMYCIN 1 GM VIAL,31010076,CDM,636,RC,J3370,HCPCS,OUTPATIENT,,,141.00,56.40,,2.61,100,,,fee schedule,100% of Aetna fee schedule,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,2.61,119.85,
VANCOMYCIN CAP: 125MG,31010077,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
ACYCLOVIR 500 MG/10 ML SDV,31010078,CDM,636,RC,J0133,HCPCS,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
ZOVIRAX CAPSULE: 200MG,31010079,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
AMIKACIN 500MG/2ML INJ:500MG,31010080,CDM,636,RC,J0278,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
PEDIAZOLE SUSP:5ML,31010081,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
E-MYCIN TAB:250 MG,31010082,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
VALACYCLOVIR 500MG,31010083,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LINEZOLID 600 MG/300 ML PREMIXED BAG,31010085,CDM,636,RC,J2020,HCPCS,OUTPATIENT,,,410.00,164.00,,,,,,other ,not seperately reimbursable,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246,60,,196.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,348.5,85,,278.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,287,70,,229.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,131.2,32,,104.96,percent of total billed charges,32% of total billed charges,131.2,348.5,
ERYPED:400 MG/5 ML,31010086,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
ZYVOX 600MG TAB:600MG,31010087,CDM,250,RC,J2020,HCPCS,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,150.45,
RETROVIR (AZT) 200MG/20ML SDV:200MG,31010088,CDM,636,RC,J3485,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
ERYTHROMYCIN IV: 1GM,31010089,CDM,636,RC,J1364,HCPCS,OUTPATIENT,,,135.00,54.00,,,,,,other ,not seperately reimbursable,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81,60,,64.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,94.5,70,,75.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,43.2,32,,34.56,percent of total billed charges,32% of total billed charges,43.2,114.75,
STREPTOMYCIN INJ:1 GM POWDER,31010090,CDM,636,RC,J3000,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
EES SUSP: 200MG/5 ML,31010091,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
RETROVIR CAPSULE: 100MG,31010092,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
TRIMPEX TAB:100 MG,31010093,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
VANCOMYCIN OPTH: DOSE,31010094,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
EES FILMTAB:400 MG,31010096,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
metroNIDAZOLE 500 MG/100 ML PREMIXED BAG,31010097,CDM,250,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
ERYTHROMYCIN INJ: 500MG,31010098,CDM,636,RC,J1364,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
PEDIAZOLE SUSP:100 ML,31010099,CDM,250,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
COMBIVIR 150/300 TABLET,31010100,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
KALETRA 200/50 TAB,31010101,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
KALETRA 100/25MG TAB,31010102,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ZIDOVUDINE 300MG TAB,31010103,CDM,250,RC,A9270,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TRUVADA 200 MG/300 MG TABLET,31010104,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
lamiVUDine 150 MG TABLET,31010105,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
AMPICILLIN/SULBACTAM 1.5 GM SDV,31010106,CDM,636,RC,J0295,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
ISENTRESS 400 MG TABLET,31010108,CDM,250,RC,,,OUTPATIENT,,,26.50,10.60,,,,,,other ,not seperately reimbursable,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.9,60,,12.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,22.53,85,,18.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,18.55,70,,14.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,8.48,32,,6.78,percent of total billed charges,32% of total billed charges,8.48,22.53,
EES SUSP:200 MG/60 ML,31010109,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
ERYC CAP:250 MG,31010111,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METRONIDAZOLE TAB 250MG,31010113,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
metroNIDAZOLE 500 MG TABLET,31010114,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUPRAX 100MGM/5ML:5ML DOSE,31010115,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
AUGMENTIN 125MG/5ML,31010118,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
AUGMENTIN 250 MG/5ML: 5ML DOSE,31010119,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CEFOBID INJ: 2GM-OFF MARKET,31010121,CDM,250,RC,,,OUTPATIENT,,,225.00,90.00,,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135,60,,108,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,157.5,70,,126,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,191.25,
cefTRIAXone 2 GM SDV,31010122,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,98.00,39.20,,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.8,60,,47.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,68.6,70,,54.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,83.3,
AMPICILLIN/SULBACTAM 3 GM SDV,31010123,CDM,636,RC,J0295,HCPCS,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
LEVAQUIN 750MG/D5W 140ML:750MG-compound,31010139,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,328.00,131.20,,,,,,other ,not seperately reimbursable,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,60,,157.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,229.6,70,,183.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,104.96,32,,83.97,percent of total billed charges,32% of total billed charges,104.96,278.8,
LEVAQUIN 500MG/20ML SDV:500MG,31010140,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,121.00,48.40,,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.6,60,,58.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,84.7,70,,67.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,102.85,
LEVAQUIN 750MG/30ML VIAL:750MG SDV(RX),31010141,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
diphenhydrAMINE/ZINC 2%-0.1% CREAM,31010142,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
AZITHROMYCIN 500 MG TABLET,31010143,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AZITHROMYCIN SUSP 100MG/5ML: 5ML DO,31010144,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AZITHROMYCIN 200 MG/5 ML DOSE - SUSP,31010145,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AZITHROMYCIN 500 MG SDV,31010146,CDM,636,RC,J0456,HCPCS,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
AZITHROMYCIN 250 MG TABLET,31010147,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BIAXIN 250MG/5ML:DOSE,31010148,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
CLARITHROMYCIN 500MG TAB: 500MG,31010149,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BIAXIN 250MG TAB:250MG,31010150,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
AZITHROMYCIN 500 MG/250 ML IVPB,31010151,CDM,636,RC,J0456,HCPCS,OUTPATIENT,,,179.00,71.60,,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.4,60,,85.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,125.3,70,,100.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,32,,45.82,percent of total billed charges,32% of total billed charges,57.28,152.15,
CLARITHROMYCIN 125MG/5ML:DOSE,31010152,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
E-MYCIN TABS 1GM,31010200,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
AMIKACIN 500MG IN NS 100ML,31010230,CDM,636,RC,J0278,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
CUBICIN 500MG NS 100ML IVPB,31010232,CDM,636,RC,J0878,HCPCS,OUTPATIENT,,,446.00,178.40,,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,379.1,
TOBRAMYCIN 80MG  NS 100ML IVPB,31010234,CDM,636,RC,J3260,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
GENTAMICIN IVPB 480MG/NS 100ML,31010250,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
OCTREOTIDE ACETATE 0.2MG/ML: MDV,31010300,CDM,250,RC,,,OUTPATIENT,,,39.75,15.90,,,,,,other ,not seperately reimbursable,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.85,60,,19.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,33.79,85,,27.03,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,27.83,70,,22.26,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,12.72,32,,10.18,percent of total billed charges,32% of total billed charges,12.72,33.79,
ZOVIRAX CREAM 2GM:2GM CRM,31010644,CDM,250,RC,,,OUTPATIENT,,,121.00,48.40,,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.6,60,,58.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,84.7,70,,67.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,32,,30.98,percent of total billed charges,32% of total billed charges,38.72,102.85,
ACYCLOVIR 200MG/5ML SUSP:5ML,31010645,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ZOVIRAX OINTMENT:3GM,31010646,CDM,250,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
ZOVIRAX CRM 5GM:5GM,31010647,CDM,250,RC,,,OUTPATIENT,,,620.00,248.00,,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372,60,,297.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,527,85,,421.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,434,70,,347.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,527,
ZOVIRAX TABLET: 800MG,31010651,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
FAMVIR TABLET: 500MG,31010652,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ZOVIRAX 5% OINTMENT:15GM,31010669,CDM,250,RC,,,OUTPATIENT,,,400.00,160.00,,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,32,,102.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,60,,192,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,32,,102.4,percent of total billed charges,32% of total billed charges,280,70,,224,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,32,,102.4,percent of total billed charges,32% of total billed charges,128,340,
ACYCLOVIR 400 MG TABLET,31010674,CDM,250,RC,,,OUTPATIENT,,,6.93,2.77,,,,,,other ,not seperately reimbursable,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,60,,3.33,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,5.89,85,,4.71,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,4.85,70,,3.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,2.22,32,,1.78,percent of total billed charges,32% of total billed charges,2.22,5.89,
ACYCLOVIR 200MG CAP,31010680,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
PROVENTIL REPEATABS:4MG,31011084,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LANTISEPTIC - 130 GM JAR,31011200,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
LANTISEPTIC MOISTURE SHIELD 113 GM TUBE,31011206,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
MINTEZOL SUSP 500/5:PER OZ,31012004,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
MINTEZOL TAB 500MG:500MG,31012005,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
NIZORAL 2% SHAMPOO:120ML,31013000,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
LOPROX CR NUMBER IS NO GOOD!,31013001,CDM,250,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
GRISOFULVIN MICROSIZE:250 MG,31013002,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NYSTATIN SUSPENSION - 5 ML UNIT DOSE CUP,31013003,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NYSTATIN POWDER - 15 GM BOTTLE,31013004,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
NYSTATIN ORAL SUSP:60ML,31013005,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
KETOCONAZOLE 2% CR 60GM:60GM,31013006,CDM,250,RC,,,OUTPATIENT,,,143.00,57.20,,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.8,60,,68.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,100.1,70,,80.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,121.55,
CIPROFLOXACIN 400MG/40ML SDV:400MG SDV,31013008,CDM,636,RC,J0744,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
CIPROFLOXACIN 200MG SDV,31013009,CDM,636,RC,J0744,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
CIPROFLOXACIN 250 MG TABLET,31013010,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CIPROFLOXACIN 500 MG TABLET,31013012,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
CIPRO IV/D5W 200MG/100ML:200MG,31013013,CDM,250,RC,,,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,107.1,
CIPRO ER FS 400MG-use 31013015*,31013014,CDM,250,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
CIPROFLOXACIN 400 MG/200 ML PREMIXED BAG,31013015,CDM,636,RC,J0744,HCPCS,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
CIPRO 200MG/20ML SDV:20ML VIAL,31013016,CDM,250,RC,,,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
CIPRO SUSPENSION 10% 500MG/5ML:100ML,31013017,CDM,250,RC,,,OUTPATIENT,,,305.00,122.00,,,,,,other ,not seperately reimbursable,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183,60,,146.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,213.5,70,,170.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,97.6,32,,78.08,percent of total billed charges,32% of total billed charges,97.6,259.25,
FLOXIN 400MG IV-NON-FORMULARY,31013018,CDM,250,RC,,,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,147.05,
FLOXIN 200MG:NON-FORMULARY,31013019,CDM,250,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
LEVAQUIN 500MG/100ML PREMIX,31013020,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,289.00,115.60,,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.4,60,,138.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,245.65,
levoFLOXacin 250 MG/50 ML - PREMIXED,31013021,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,6.90,2.76,,,,,,other ,not seperately reimbursable,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.14,60,,3.31,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,5.87,85,,4.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,4.83,70,,3.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,2.21,32,,1.77,percent of total billed charges,32% of total billed charges,2.21,5.87,
LEVOFLOXACIN TABLET 500MG,31013022,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
TEQUIN 400MG TAB:400MG,31013023,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
TEQUIN 400MG/200ML IV:400MG,31013024,CDM,636,RC,J1590,HCPCS,OUTPATIENT,,,227.00,90.80,,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.2,60,,108.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,158.9,70,,127.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,192.95,
TEQUIN 200MG/100ML IV:200MG IV,31013025,CDM,636,RC,J1590,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,45.6,40,,36.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,96.9,
LEVAQUIN 250MG TAB:250MG,31013026,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14,40,,11.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
levoFLOXacin 750 MG/D5 150 ML - PREMIXED,31013027,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,7.53,3.01,,,,,,other ,not seperately reimbursable,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.52,60,,3.62,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,6.4,85,,5.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,5.27,70,,4.22,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,2.41,32,,1.93,percent of total billed charges,32% of total billed charges,2.41,6.4,
LEVAQUIN 500MG/100ML PREMIX,31013028,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,289.00,115.60,,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.4,60,,138.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,202.3,70,,161.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,32,,73.98,percent of total billed charges,32% of total billed charges,92.48,245.65,
LEVAQUIN 750MG TAB:750MG,31013029,CDM,250,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
AVELOX 400MG/250ML IVPB:400MG,31013030,CDM,250,RC,J2280,HCPCS,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,105.4,
levoFLOXacin 750 MG TABLET,31013040,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CEFUROXIME AXETIL TAB: 250MG,31013101,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CEFTIN TABLET: 500MG,31013103,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
CEFTIN 125MG/ 5ML DOSE,31013104,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
VANTIN TABLET: 100MG,31013105,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
VANTIN TABLET: 200MG,31013106,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
CEFZIL 125MG/5ML 50ML:50ML,31013107,CDM,250,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
CEFPROZIL 250MG/5ML 50ML:5ML DOSE,31013108,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
DYNAPEN CAP:250 MG,31014001,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DICLOXACILLIN 500MG CAP:500MG,31014002,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
AMOXICILLIN CAP : 250MG,31014005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMOXICILLIN 500 MG CAPSULE,31014006,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PENTOXIFYLLINE TAB 400MG:400MG,31014007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CILOSTAZOL 100MG:100MG,31014008,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PEN VK TAB:250MG,31014011,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PEN VK TAB:500MG,31014012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMOXIL SUSP 250MG/5ML:5ML DOSE,31014013,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AMPICILLIN SUSP 250MG/5ML : 100 ML,31014015,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
PEN VK SUSP:250MG/5ML- 100 ML,31014022,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
AMPICILLIN CAP : 250 MG,31014025,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMPICILLIN CAP : 500 MG,31014026,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMPICILLIN INJ : 250 MG,31014028,CDM,636,RC,J0290,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,5.06,42.5,
AMPICILLIN INJ 500 MG,31014029,CDM,636,RC,J0290,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,5.06,45.9,
AMPICILLIN 1GM IV,31014030,CDM,636,RC,J0290,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,5.06,48.45,
AMPICILLIN 2GM,31014031,CDM,636,RC,J0290,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,5.06,57.8,
OXACILLIN INJ: 2GM,31014042,CDM,636,RC,J2700,HCPCS,OUTPATIENT,,,174.00,69.60,,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,7.62,272,,,fee schedule,272% of BCBS fee schedule,7.62,272,,,fee schedule,272% of BCBS fee schedule,7.62,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,104.4,60,,83.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,121.8,70,,97.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,55.68,32,,44.54,percent of total billed charges,32% of total billed charges,7.62,147.9,
NAFCILLIN 1GM SDV: 1GM,31014043,CDM,251,RC,,,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
NAFCILLIN 2GM/NS 100ML IVPB:2GM IVPB,31014046,CDM,250,RC,,,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
PEN GK INJ:1 MU,31014047,CDM,636,RC,J2540,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
PEN G PROC:1.2 MILL U,31014048,CDM,636,RC,J0558,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
PENICILLIN G POT INJ:2000000 U,31014049,CDM,636,RC,J2540,HCPCS,OUTPATIENT,,,127.00,50.80,,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.2,60,,60.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,88.9,70,,71.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,107.95,
NYSTATIN CREAM - 15 GM TUBE,31014050,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
NAFCILLIN 2GM SDV: 2GM,31014051,CDM,251,RC,,,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
NAFCILLIN 1GM/NS 100ML IVPB: 1GM IVPB,31014052,CDM,250,RC,,,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
PEN G PROC:2.4 MILLU TUBEX,31014053,CDM,636,RC,J0558,HCPCS,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,96.05,
BICILLIN CR INJ:1.2 MILU TBX,31014054,CDM,636,RC,J0558,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
BICILLIN LA TUBEX 1.2 MU,31014055,CDM,636,RC,J0561,HCPCS,OUTPATIENT,,,160.00,64.00,,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
PRIMAXIN 500MG SDV: 500MG,31014056,CDM,636,RC,J0743,HCPCS,OUTPATIENT,,,166.00,66.40,,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,141.1,
PRIMAXIN 250 MG SDV,31014057,CDM,636,RC,J0743,HCPCS,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,115.6,
INVanz 1 GM/NS 100 ML IVPB,31014058,CDM,636,RC,J1335,HCPCS,OUTPATIENT,,,166.00,66.40,,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,141.1,
BICILLIN CR TUBEX: 900/300MU,31014059,CDM,250,RC,,,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
CUBICIN 500MG SDV:500MG,31014060,CDM,636,RC,J0878,HCPCS,OUTPATIENT,,,446.00,178.40,,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.6,60,,214.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,312.2,70,,249.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,32,,114.18,percent of total billed charges,32% of total billed charges,142.72,379.1,
PENICILLIN G K 5MMU:5 MILLION UNITS,31014061,CDM,636,RC,J2540,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
PROSTAPHYLIN CAPSULE:250MG,31014062,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ERTAPENEM 1 GM SDV,31014063,CDM,636,RC,J1335,HCPCS,OUTPATIENT,,,166.00,66.40,,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,141.1,
INVanz 2 GM/NS 100 ML IVPB,31014064,CDM,636,RC,J1335,HCPCS,OUTPATIENT,,,166.00,66.40,,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,141.1,
OXACILLIN 1GM IV:1GM,31014065,CDM,636,RC,J2700,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,7.62,272,,,fee schedule,272% of BCBS fee schedule,7.62,272,,,fee schedule,272% of BCBS fee schedule,7.62,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,7.62,90.1,
INVanz 0.5Gm/NS 50ml IVPB:500mg,31014066,CDM,636,RC,J1335,HCPCS,OUTPATIENT,,,166.00,66.40,,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.6,60,,79.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,116.2,70,,92.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,32,,42.5,percent of total billed charges,32% of total billed charges,53.12,141.1,
AMOXIL SUSP:125 MG/5 ML U-D,31014067,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AMOXIL SUSP 250MG/5 ML DOSE,31014068,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
PRIMAXIN 500 MG SDV,31014069,CDM,636,RC,J0743,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
BICILLIN CR INJ:2.4 MU TUBEX,31014070,CDM,250,RC,,,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
BICILLIN CR:600000 UNITS,31014072,CDM,250,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
NYSTATIN OINTMENT - 15 GM TUBE,31014076,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
MUPIROCIN 2% OINTMENT  - 1 GM TUBE,31014077,CDM,250,RC,,,OUTPATIENT,,,6.25,2.50,,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.75,60,,3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,5.31,85,,4.25,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,4.38,70,,3.5,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,5.31,
AMOXICILLIN/CLAV 200/28.5MG:75ML,31014080,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
ZOSYN 2.25 GM/50 ML NS,31014082,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,115.00,46.00,,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,97.75,
AMOX/CLAV 875 MG/125 MG TABLET,31014097,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
AUGMENTIN SUSP 125MG/5ML :75ML,31014098,CDM,250,RC,,,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,96.05,
AMOXIL/CLAV 250/125MG TAB: 250MG,31014099,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
AUGMENTIN TAB 500MG,31014100,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
AUGMENTIN SUSP:75ML 250MG/5ML,31014101,CDM,250,RC,,,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
TIMENTIN SDV 3.1GM:3.1 GM,31014102,CDM,250,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
ZOSYN 2.25 GM VIAL,31014104,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
ZOSYN IVPB:3.375GM(BRAND),31014105,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,96.9,
PIPERACILLIN/TAZOBACTAM 4.5 GM VIAL,31014106,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
AMOXICILLIN/CLAV 400/57MG 5ML DOSE,31014107,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AMOXICILLIN/CLAV K 600MG/5ML:5ML,31014108,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AMOXICILLIN 400MG/5ML 5ML DOSE,31014109,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
TIMENTIN 2GM/NS 50ML,31014110,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PIPERACILLIN/TAZOBAC 3.375 GM/100 ML NS,31014111,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,55.25,
ZOSYN IVPB:3.375GM(Bad #),31014112,CDM,250,RC,,,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,96.9,
PIPERACILLIN/TAZOBACTAM 3.375 GM VIAL,31014113,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,55.25,
PIP/TAZO 3.375GM/  100ML :3.375GM,31014120,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,65.00,26.00,,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39,60,,31.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,45.5,70,,36.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,32,,16.64,percent of total billed charges,32% of total billed charges,20.8,55.25,
PEN G PROC:600000,31014541,CDM,636,RC,J0558,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
PEN GK INJ: 10 MU,31014548,CDM,636,RC,J2540,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
PEN GK INJ: 2 MU,31014648,CDM,636,RC,J2540,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
DEMECLOCYCLINE TAB: 150MG,31015016,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TETRACYCLINE CAP:250 MG,31015017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TETRACYCLINE SUSP:1 OZ,31015018,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
DECLOMYCIN TABLET: 300MG,31015019,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
DOXYCYCLINE 100 MG IV,31015028,CDM,250,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE,31015030,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
MINOCYCLINE 100MG CAP:100MG,31015031,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
ETHAMBUTOL TAB 100MG:100MG,31016002,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ETHAMBUTOL 400 MG TABLET,31016003,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
rifAMPin 300 MG CAPSULE,31016004,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
RIFAMPIN IV 600MG:600MG,31016005,CDM,250,RC,,,OUTPATIENT,,,198.00,79.20,,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.8,60,,95.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,138.6,70,,110.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,32,,50.69,percent of total billed charges,32% of total billed charges,63.36,168.3,
PYRAZINAMIDE 500 MG TABLET,31016007,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ISONIAZID 300 MG TABLET,31016008,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BACTRIM DS EQ 800 MG/160 MG TAB,31018022,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SULFATRIM SUSPENSION - PER 1 ML,31018023,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
BACTRIM IV:BAD # USE 31018025,31018024,CDM,250,RC,,,OUTPATIENT,,,127.00,50.80,,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.2,60,,60.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,88.9,70,,71.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,107.95,
COTRIMOXAZOLE(SMX/TMP)MDV 10ML,31018025,CDM,636,RC,S0039,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
CEPHALEXIN CAP:250MG,31019002,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
CEPHALEXIN 500 MG CAPSULE,31019003,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CEPHALEXIN SUSP 250MG/5ML:100ML,31019004,CDM,250,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
ceFAZolin 500 MG SDV,31019008,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ceFAZolin 1 GM SDV,31019009,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
CEFOTETAN: 1GM,31019010,CDM,259,RC,,,OUTPATIENT,,,141.00,56.40,,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,119.85,
CEFOTETAN: 2GM,31019011,CDM,259,RC,,,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,107.1,
"BACITRACIN 50,000 UNITS SDV",31019012,CDM,259,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
CEFDINIR 300MG CAP,31019014,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CEFDINIR SUSP 250MG/5ML,31019015,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
MEFOXIN INJ:1GM IN/IV,31019024,CDM,636,RC,J0694,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
MYCELEX TROCHE-USE #31019026,31019025,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CLOTRIMAZOLE TROCHE 10MG:10MG,31019026,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CEFOXITIN IV:2GM,31019030,CDM,250,RC,,,OUTPATIENT,,,127.00,50.80,,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.2,60,,60.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,88.9,70,,71.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,107.95,
CEFOTAXIME INJ:1 GM IM/IV,31019031,CDM,636,RC,J0698,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CEFADROXIL CAP:500 MG,31019032,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CLAFORAN IV:2GMS,31019033,CDM,636,RC,J0698,HCPCS,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
CEFOTAXIME 500MG SDV,31019034,CDM,636,RC,J0698,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
TOBRADEX OPH DROPS,31019035,CDM,250,RC,,,OUTPATIENT,,,155.00,62.00,,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93,60,,74.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,108.5,70,,86.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,32,,39.68,percent of total billed charges,32% of total billed charges,49.6,131.75,
TOBRADEX OINT,31019036,CDM,250,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
TOBRADEX OPTH DROPS DOSE:DOSE,31019037,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
AZACTAM 2GM:2GM,31019041,CDM,250,RC,,,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
AZACTAM 1GM SDV:1GM,31019042,CDM,250,RC,,,OUTPATIENT,,,98.00,39.20,,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.8,60,,47.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,68.6,70,,54.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,83.3,
CEFUROXIME IV: 750MG,31019043,CDM,250,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
CEFTAZIDIME 1 GM IV,31019044,CDM,636,RC,J0713,HCPCS,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
cefTAZidime 2 GM SDV,31019045,CDM,636,RC,J0713,HCPCS,OUTPATIENT,,,187.00,74.80,,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.2,60,,89.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,130.9,70,,104.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,158.95,
ZINACEF IV: 1.5GM,31019046,CDM,636,RC,J0697,HCPCS,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,107.1,
MAXIPIME IVPB 1GM:(BRAND NAME),31019047,CDM,636,RC,J0692,HCPCS,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
CEFEPIME 1 GM/NS 50 ML,31019048,CDM,636,RC,J0692,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CEFEPIME 1 GM SDV,31019049,CDM,636,RC,J0692,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CEFTAZIDIME 1GM/NS 100ML IVPB:1GM,31019050,CDM,636,RC,J0713,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CEFEPIME 1GM/NS 50ml IVPB:(BAD #  !!!),31019051,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CEFEPIME 1GM/NS 50ML IVPB:1GM,31019052,CDM,636,RC,J0692,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
ROCEPHIN 750 MG/NS 10 ML - PEDIATRIC,31019054,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
cefTRIAXone 1 GM SDV,31019055,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
cefTRIAXone 250 MG SDV,31019057,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
cefTRIAXone 500 MG SDV,31019058,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
CEFADROXIL 250MG/5ML 100ML,31019080,CDM,250,RC,,,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,107.1,
E.E.S. GRANULES 200MG/5ML 100ML,31019082,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
ERYTHROMYCIN 500MG IVPB 100ML ADD-VANT,31019090,CDM,636,RC,J1364,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
CEPHALEXIN 250MG/5ML 5ML DOSE,31019504,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
CEPHALEXIN 125MG/2.5ML:5ML DOSE,31019604,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
CIPRO TABLET: 750MG,31019613,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
MONISTAT 7 VAG SUPP:EACH,31019620,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
DURICEF 250 MG/5ML: 50 ML,31019703,CDM,250,RC,,,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
DURICEF 250 MG/5ML: 5 ML,31019704,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
URECHOLINE:10 MG,31020009,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BETHANECHOL 10 MG TABLET,31021009,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
URECHOLINE TAB: 25MG,31021010,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PROSTIGMIN INJ:1 2000 1ML,31021011,CDM,636,RC,J2710,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
MESTINON TAB 60MG:60MG,31021012,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
NEOSTIGMINE 1 MG/ML MDV - CHARGED PER ML,31021013,CDM,636,RC,J2710,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
SUGGAMMADEX 200 MG/2 ML SDV,31021014,CDM,250,RC,,,OUTPATIENT,,,110.00,44.00,,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,60,,52.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,77,70,,61.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,32,,28.16,percent of total billed charges,32% of total billed charges,35.2,93.5,
PHYSOSTIGMINE 2MG/2ML: 2 ML,31021015,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
URECHOLINE INJ:5MG/1 ML,31021016,CDM,636,RC,J0520,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
TENSILON:1ML,31021019,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ARTANE TAB : 2 MG,31022001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DAPSONE 100MG:100MG,31022006,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DICYCLOMINE 10 MG CAPSULE,31022007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DICYCLOMINE 20MG TAB,31022008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SULFASALAZINE 500MG TAB:500MG,31022009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DELZICOL 400MG TAB,31022010,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
PENTASA  CR CAPS 250MG:250MG,31022011,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ASACOL 800MG TAB:800MG,31022012,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
BENZTROPINE 0.5 MG TABLET,31022013,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BENZTROPINE TAB 1MG:1MG,31022014,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BENZTROPINE TAB:2MG,31022015,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ATROPINE SDV 1MG/ML,31022037,CDM,636,RC,J0461,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
DICYCLOMINE 20 MG/2 ML SDV,31022040,CDM,636,RC,J0500,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
DICYCLOMINE 10 MG/5 ML ORAL SOL - PER ML,31022041,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
COGENTIN INJ 1 MG /ML 2 ML EQU,31022042,CDM,250,RC,,,OUTPATIENT,,,108.00,43.20,,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,60,,51.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,75.6,70,,60.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,91.8,
GLYCOPYRROLATE 0.2MG/ML,31022045,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
ATROPINE 1 MG/10 ML PREFILLED SYRINGE,31022051,CDM,636,RC,J0461,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
TRANSDERM SCOP 1 MG/3 DAY PATCH,31022054,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
ATROPINE:0.25MG/5 ML CARDIAC,31022055,CDM,250,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
MESALAMINE 4GM/60ML:60ML,31022539,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
ALUPENT TAB:20 MG,31023001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
glipiZIDE 5 MG TABLET,31023007,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GLUCOTROL XL 5MG TAB: 5MG,31023008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
glipiZIDE ER 10 MG TABLET,31023009,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GLIPIZIDE ER 2.5MG TAB,31023010,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ARAMINE INJ 1% VIAL:10ML,31023018,CDM,250,RC,,,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,35.6,40,,28.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,75.65,
EPHEDRINE 50 MG/ML SDV,31023021,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18,40,,14.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
ADRENALIN 1 MG/ML AMPULE,31023022,CDM,636,RC,J0171,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
ISUPREL INJ 1-5000:5 ML,31023023,CDM,250,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
ISUPREL INJ 1-5000:1 ML,31023024,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
NOREPINEPHRINE 4 MG/4 ML VIAL,31023025,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
THEOPHYLLINE ER 200 MG TABLET,31023026,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ADRENALIN 1/1000 MDV : 30ML,31023027,CDM,636,RC,J0171,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
EPINEPHrine 1 MG/ML SDV,31023028,CDM,636,RC,J0171,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
EPINEPHrine 30MG/30ML MDV,31023029,CDM,636,RC,J0171,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
LEVOPHED DRIP 4 MG/D5W 250 ML,31023030,CDM,250,RC,,,OUTPATIENT,,,12.42,4.97,,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.45,60,,5.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,10.56,85,,8.45,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,8.69,70,,6.95,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,32,,3.18,percent of total billed charges,32% of total billed charges,3.97,10.56,
PHENYLEPHRINE 10 MG/ML SDV,31023034,CDM,636,RC,J2371,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SLOBID CAP: 100MG,31023035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SLOBID CAP: 300MG,31023036,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUS PHRINE INJ 1-200:0.3 ML,31023037,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
ALBUTEROL SYRUP 2MG/5ML:2MG,31023038,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ALBUTEROL  ER 4MG TAB,31023039,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
RHINOCORT-AQUA :NF- USE FLONASE,31023040,CDM,250,RC,,,OUTPATIENT,,,151.00,60.40,,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.6,60,,72.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,105.7,70,,84.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,128.35,
DESMOPRESSIN NSL SP 5ML:5ML,31023042,CDM,250,RC,,,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
SPACER FOR MDI,31023043,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
AZMACORT INHALER:20 GM,31023044,CDM,250,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
ALUPENT INHALER:15 ML,31023045,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
ACETYLCYSTIENE 20%  RT VIAL 30ML,31023046,CDM,250,RC,,,OUTPATIENT,,,99.00,39.60,,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,60,,47.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,69.3,70,,55.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,32,,25.34,percent of total billed charges,32% of total billed charges,31.68,84.15,
ACETYLCYSTIENE 20%(4ML)800MG:800MG,31023047,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
EPINEPHrine 1 MG/10 ML PREFILLED SYRINGE,31023048,CDM,636,RC,J0171,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
EPINEPHR INJ 18X3 5 P F,31023049,CDM,636,RC,J0171,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
FLUTICASONE NASAL SPRAY - 16 GM BOTTLE,31023050,CDM,250,RC,,,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,96.9,
VANCENASE AQ : NF- USE FLONASE,31023051,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
TERBUTALINE 1MG/ML SDV:1MG,31023053,CDM,250,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
SLOBID CAP: 200MG,31023054,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SLOBID CAP: 50MG,31023056,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
Ventolin HFA MDI:USE IN OR ONLY,31023057,CDM,250,RC,,,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
TERBUTALINE 2.5MG TAB:2.5MG,31023058,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ACETYLCYSTEINE 10% 4ML,31023059,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
"SEREVENT MDI -OFF MARKET, USE DISKUS",31023060,CDM,250,RC,,,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,115.6,
ACETYLCYSTEINE 20% 4ML 800MG:800MG,31023061,CDM,636,RC,J0132,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
VENTOLIN TAB: 2 MG,31023062,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
RT-COMBIVENT MDI:MDI,31023063,CDM,250,RC,,,OUTPATIENT,,,214.00,85.60,,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.4,60,,102.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,181.9,85,,145.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,149.8,70,,119.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,32,,54.78,percent of total billed charges,32% of total billed charges,68.48,181.9,
NASACORT AQ : NF- USE FLONASE,31023066,CDM,250,RC,,,OUTPATIENT,,,143.00,57.20,,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.8,60,,68.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,100.1,70,,80.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,121.55,
SEREVENT DISKUS 50MCG:DISKUS,31023068,CDM,250,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
ADVAIR DISKUS 500/50:500/50,31023069,CDM,250,RC,,,OUTPATIENT,,,314.00,125.60,,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.4,60,,150.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,219.8,70,,175.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,32,,80.38,percent of total billed charges,32% of total billed charges,100.48,266.9,
ADVAIR DISKUS 100/50:100/50,31023070,CDM,250,RC,,,OUTPATIENT,,,227.00,90.80,,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.2,60,,108.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,158.9,70,,127.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,32,,58.11,percent of total billed charges,32% of total billed charges,72.64,192.95,
ADVAIR DISKUS 250/50:250/50,31023071,CDM,250,RC,,,OUTPATIENT,,,284.00,113.60,,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.4,60,,136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,241.4,85,,193.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,198.8,70,,159.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,241.4,
TERBUTALINE 5MG TAB:5MG,31023072,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
RT-ALBUTEROL 2.5MG/3ML NEB,31023080,CDM,251,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
RT-ACETYLCYSTEINE TXMENT,31023084,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
SYMBICORT 80/4.5 MDI:MDI,31023087,CDM,250,RC,,,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
SYMBICORT 80/4.5MCG MDI:MDI,31023088,CDM,250,RC,,,OUTPATIENT,,,275.00,110.00,,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165,60,,132,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,192.5,70,,154,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,32,,70.4,percent of total billed charges,32% of total billed charges,88,233.75,
SYMBICORT 160/4.5,31023090,CDM,250,RC,,,OUTPATIENT,,,284.00,113.60,,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.4,60,,136.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,241.4,85,,193.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,198.8,70,,159.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,32,,72.7,percent of total billed charges,32% of total billed charges,90.88,241.4,
VENTOLIN HFA 18GM MDI:18GM,31023092,CDM,250,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
RT-SODIUM CHLORIDE 3% NEB 4ML,31023096,CDM,251,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
ALBUTEROL 6.7GM MDI,31023098,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
MUCOMYST 20%:10ML,31023100,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
ACETYLCYSTEINE 600MG,31023105,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
ASTELIN NASAL SPY 30ML,31023110,CDM,250,RC,,,OUTPATIENT,,,212.00,84.80,,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.2,60,,101.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,148.4,70,,118.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,32,,54.27,percent of total billed charges,32% of total billed charges,67.84,180.2,
SALINE NASAL SPRAY 0.65% - 44 ML BOTTLE,31023112,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACETYLCYSTEINE  6GM  IV 30ML VIAL,31023120,CDM,636,RC,J0132,HCPCS,OUTPATIENT,,,189.00,75.60,,,,,,other ,not seperately reimbursable,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.4,60,,90.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,132.3,70,,105.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,60.48,32,,48.38,percent of total billed charges,32% of total billed charges,60.48,160.65,
DHE EQ 1MG/ML:1MG,31024010,CDM,636,RC,J1110,HCPCS,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
SUMAtriptan SUCCINATE 6 MG/0.5 ML SDV,31024011,CDM,636,RC,J3030,HCPCS,OUTPATIENT,,,246.00,98.40,,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.6,60,,118.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,172.2,70,,137.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,32,,62.98,percent of total billed charges,32% of total billed charges,78.72,209.1,
IMITREX TABLET: 25MG,31024012,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
CAFERGOT 1/100 TAB:1/100,31024013,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
CAFEGOT SUPP PLAIN,31024014,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
PROVENTIL EXTENTABS:4MG,31024015,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HYDERGINE TAB:ORAL 1 MG EQUIV,31024017,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SUMATRIPTAN 50MG TAB,31024018,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
IMITREX 100MG TAB:100MG,31024019,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
ARICEPT 5 MG TABLET,31024020,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ARICEPT TAB : 10 MG-use gen #24037,31024021,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
RISPERIDONE 1MG TAB,31024022,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
RISPERIDONE 0.25MG TAB: 0.25MG,31024023,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SEROQUEL 200MG:200MG,31024024,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SEROquel 100 MG TABLET,31024025,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
QUEtiapine 25 MG TABLET,31024026,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
risperiDONE 0.5 MG TABLET,31024027,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
RAZADYNE 8MG:8MG,31024028,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MEMANTINE 5 MG TABLET,31024029,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MEMANTINE 10 MG TABLET,31024030,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ABILIFY 10MG TAB,31024031,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
RISPERDAL CONSTA 25MG IM:25MG,31024032,CDM,636,RC,J2794,HCPCS,OUTPATIENT,,,598.00,239.20,,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.8,60,,287.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,508.3,85,,406.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,418.6,70,,334.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,191.36,508.3,
ARIPiprazole 5 MG TAB,31024033,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
QUETIAPINE 50MG:50MG,31024034,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
EXELON 4.6MG/24HR PATCH,31024035,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
EXELON 9.5MG/24HR PATCH,31024036,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
DONEPEZIL 10 MG TABLET,31024037,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DANTRIUM CAP:25 MG,31025001,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ORPHENADRINE ER 100 MG TABLET,31025005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PARAFON FORTE TABLET: EQ,31025007,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ROBAXIN TAB: 500MG EQ,31025010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ROBAXIN TAB: 750MG EQ,31025011,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ROBAXISAL TAB: EQ,31025012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ORPHENADRINE 60MG/2ML SDV,31025014,CDM,636,RC,J2360,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
ROBAXIN 1000MG/10ML INJ: 100MG/ML,31025015,CDM,636,RC,J2800,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
TUBOCURARINE INJ 3 MG/ML:10 ML,31025019,CDM,250,RC,,,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
PANCURONIUM HBR 1MG/ML 10ML MDV:10MG,31025021,CDM,250,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
DOXCURIN:1MG,31025022,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
BACLOFEN 10 MG TABLET,31025023,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CYCLOBENZAPRINE 10 MG TABLET,31025024,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SKELALXIN 400MG:DISCONTINUED BAD #,31025025,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DANTRIUM INJ IV:20 MG/60 ML,31025026,CDM,250,RC,,,OUTPATIENT,,,293.00,117.20,,,,,,other ,not seperately reimbursable,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.8,60,,140.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,249.05,85,,199.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,205.1,70,,164.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,93.76,32,,75.01,percent of total billed charges,32% of total billed charges,93.76,249.05,
VECURONIUM VIAL 10MG,31025027,CDM,251,RC,,,OUTPATIENT,,,182.00,72.80,,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.2,60,,87.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,127.4,70,,101.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,32,,46.59,percent of total billed charges,32% of total billed charges,58.24,154.7,
tiZANidine 4 MG TABLET,31025028,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
BACLOFEN TAB 20MG:20MG,31025029,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TRACRIUM IV:1ML,31025030,CDM,250,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
MIVACRON:2MG/1ML,31025031,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
NIMBEX 2MG/ML 1 ML DOSE,31025032,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
ZEMURON 10MG/ML DOSE,31025033,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
RAPACURONIUM 20MG/ML:1ML,31025035,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
SKELAXIN 800MG:800MG,31025036,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CYCLOBENZAPRINE 5MG:5MG,31025037,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CHLORHEXIDENE ORAL RINSE - 480 ML BOTTLE,31025489,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
CENTAMIN LIQ 15ML:15ML,31031003,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FOLIC ACID 1 MG TABLET,31031004,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CALCIUM/VIT D 500/200 TAB,31031005,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEUPOGEN 480MCG SYRINGE,31031006,CDM,636,RC,J1442,HCPCS,OUTPATIENT,,,860.00,344.00,,,,,,other ,not seperately reimbursable,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516,60,,412.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,731,85,,584.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,602,70,,481.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,275.2,32,,220.16,percent of total billed charges,32% of total billed charges,275.2,731,
ARANESP 100MCG/0.5ML INJ:100MCG,31031007,CDM,636,RC,,,OUTPATIENT,,,1692.00,676.80,,,,,,other ,not seperately reimbursable,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1015.2,60,,812.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,1438.2,85,,1150.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,1184.4,70,,947.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,541.44,32,,433.15,percent of total billed charges,32% of total billed charges,541.44,1438.2,
ARANESP 40MCG/ML:40MG,31031008,CDM,636,RC,,,OUTPATIENT,,,280.00,112.00,,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,60,,134.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,196,70,,156.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,238,
VI-DAYLIN LIQUID VITAMIN:5 ML,31031009,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ELDERTONIC:15ML DOSE,31031010,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
"PROCRIT 20,000 UNITS/ML:NON-ESRD",31031011,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,660.00,264.00,,8.82,100,,,fee schedule,100% of Aetna fee schedule,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,60,,316.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,561,85,,448.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,462,70,,369.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,211.2,32,,168.96,percent of total billed charges,32% of total billed charges,8.82,561,
"ERYTHROPOETIN ALFA - PER 1,000 UNITS",31031012,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,35.00,14.00,,8.82,100,,,fee schedule,100% of Aetna fee schedule,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,8.82,29.75,
"EPOGEN 2,000U/ML:EPOGEN 2000U",31031013,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,127.00,50.80,,8.82,100,,,fee schedule,100% of Aetna fee schedule,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.2,60,,60.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,88.9,70,,71.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,8.82,107.95,
"EPOGEN 4,000U/ML:EPOGEN 4000U",31031014,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,273.00,109.20,,8.82,100,,,fee schedule,100% of Aetna fee schedule,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.8,60,,131.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,191.1,70,,152.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,87.36,32,,69.89,percent of total billed charges,32% of total billed charges,8.82,232.05,
NEUPOGEN 300MCG/0.5ML:300MCG,31031015,CDM,636,RC,J1442,HCPCS,OUTPATIENT,,,583.00,233.20,,,,,,other ,not seperately reimbursable,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.8,60,,279.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,495.55,85,,396.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,408.1,70,,326.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,186.56,32,,149.25,percent of total billed charges,32% of total billed charges,186.56,495.55,
NEUPOGEN 480MCG SDV:480MCG SDV,31031016,CDM,636,RC,J1442,HCPCS,OUTPATIENT,,,773.00,309.20,,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,463.8,60,,371.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,657.05,85,,525.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,541.1,70,,432.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,247.36,32,,197.89,percent of total billed charges,32% of total billed charges,247.36,657.05,
"PROCRIT 40,000 UNIT :NON-ESRD",31031017,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,2564.00,1025.60,,8.82,100,,,fee schedule,100% of Aetna fee schedule,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1538.4,60,,1230.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,2179.4,85,,1743.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,1794.8,70,,1435.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,820.48,32,,656.38,percent of total billed charges,32% of total billed charges,8.82,2179.4,
PROCRIT 10MU/ML:10000 UNITS,31031018,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,479.00,191.60,,8.82,100,,,fee schedule,100% of Aetna fee schedule,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.4,60,,229.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,407.15,85,,325.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,335.3,70,,268.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,153.28,32,,122.62,percent of total billed charges,32% of total billed charges,8.82,407.15,
FERROUS SULF EL 220MG/5ML,31031019,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
FER-IN SOL DROPS:50 ML,31031020,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
FERROUS SULF EL UD 300MG/5ML:5ML,31031021,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
FERROUS SULFATE 325 MG TABLET,31031022,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEPHRO-VITE EQ TAB,31031023,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SLOW-FE TAB: 50MG EQ,31031024,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
IMFERON INJ 50 MGFE/ML 2 ML,31031025,CDM,636,RC,J1750,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
FERO-FOLIC TAB:500 MG,31031034,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FERREX 150MG CAP:150MG,31031035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ARANESP 40 MCG/ML ESRD,31031040,CDM,636,RC,J0882,HCPCS,OUTPATIENT,,,280.00,112.00,,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,60,,134.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,196,70,,156.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,238,
KLOR-CON 10 MEQ TABLET,31031099,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
COUMADIN TAB 1MG,31032001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
WARFARIN 2.5 MG TABLET,31032002,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
WARFARIN 7.5 MG TABLET,31032003,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
WARFARIN 10 MG TABLET,31032004,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LEVOTHYROXINE INJ SDV 200MCG,31032005,CDM,250,RC,,,OUTPATIENT,,,280.00,112.00,,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,60,,134.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,196,70,,156.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,238,
COUMADIN TAB 4MG,31032006,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
WARFARIN 5 MG TABLET,31032007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
WARFARIN 2 MG TABLET,31032008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PLAVIX TAB 75MG(Brand name),31032009,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
COUMADIN 3 MG TABLET,31032010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CLOPIDOGREL 75 MG TABLET,31032011,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CERVIDIL VAG TAB:10MG,31032013,CDM,250,RC,,,OUTPATIENT,,,620.00,248.00,,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372,60,,297.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,527,85,,421.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,434,70,,347.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,32,,158.72,percent of total billed charges,32% of total billed charges,198.4,527,
HEPARIN 25000 UNITS/500 ML .45% NS,31032015,CDM,636,RC,J1644,HCPCS,OUTPATIENT,,,12.28,4.91,,,,,,other ,not seperately reimbursable,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.37,60,,5.9,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,10.44,85,,8.35,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,8.6,70,,6.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,3.93,32,,3.14,percent of total billed charges,32% of total billed charges,3.93,10.44,
ENOXAPARIN 40 MG/0.4 ML,31032016,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,80.70,32.28,,,,,,other ,not seperately reimbursable,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.42,60,,38.74,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,68.6,85,,54.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,56.49,70,,45.19,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,25.82,32,,20.66,percent of total billed charges,32% of total billed charges,25.82,68.6,
ENOXAPARIN 30 MG/0.3 ML,31032017,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
PITOCIN 10 UNITS/ML,31032018,CDM,636,RC,J2590,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
NS 10ML FLUSH SYRINGE,31032019,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
ENOXAPARIN 60 MG/0.6 ML,31032020,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,207.00,82.80,,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.2,60,,99.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,144.9,70,,115.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,32,,52.99,percent of total billed charges,32% of total billed charges,66.24,175.95,
ENOXAPARIN 80 MG/0.8 ML,31032021,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,258.00,103.20,,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.8,60,,123.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,180.6,70,,144.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,219.3,
ENOXAPARIN 100 MG/ML,31032022,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,288.00,115.20,,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.8,60,,138.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,201.6,70,,161.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,92.16,32,,73.73,percent of total billed charges,32% of total billed charges,92.16,244.8,
FRAGMIN 5000 UNITS. SQ:5000 UNITS,31032023,CDM,250,RC,J1645,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
ARIXTRA 0.5MG/0.1ML INJ:2.5MG/0.5ml,31032024,CDM,636,RC,J1652,HCPCS,OUTPATIENT,,,194.00,77.60,,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.4,60,,93.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,135.8,70,,108.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,32,,49.66,percent of total billed charges,32% of total billed charges,62.08,164.9,
HEPARIN FLUSH 100 UNITS/ML - 5ML SYRINGE,31032025,CDM,636,RC,J1642,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ENOXAPARIN 120 MG/0.8 ML,31032026,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,307.00,122.80,,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.2,60,,147.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,260.95,85,,208.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,214.9,70,,171.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,32,,78.59,percent of total billed charges,32% of total billed charges,98.24,260.95,
FRAGMIN 2500 UNITS SC:2500 UNITS,31032027,CDM,250,RC,J1645,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
FRAGMIN 15 000 UNITS.15 000 UNITS,31032028,CDM,250,RC,J1645,HCPCS,OUTPATIENT,,,243.00,97.20,,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.8,60,,116.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,170.1,70,,136.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,206.55,
"FRAGMIN 18 000 UNITS:18,000 UNITS",31032029,CDM,636,RC,J1645,HCPCS,OUTPATIENT,,,365.00,146.00,,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219,60,,175.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,255.5,70,,204.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,32,,93.44,percent of total billed charges,32% of total billed charges,116.8,310.25,
FRAGMIN 7500 UNITS/0.3ML:7500 UNITS,31032030,CDM,636,RC,J1645,HCPCS,OUTPATIENT,,,151.00,60.40,,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.6,60,,72.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,105.7,70,,84.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,128.35,
"FRAGMIN 10,000 UNITS/ML:10MU",31032032,CDM,258,RC,J1645,HCPCS,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
HEPARIN 25000 UNITS / NS 500ML,31032040,CDM,636,RC,J1644,HCPCS,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,141.95,
ELIQUIS 2.5 MG TABLET,31032044,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PRADAXA 75 MG CAPSULE,31032048,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
PRADAXA 150MG CAPSULE,31032050,CDM,250,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
XARELTO 15 MG TABLET,31032054,CDM,250,RC,,,OUTPATIENT,,,11.20,4.48,,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,60,,5.38,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,9.52,85,,7.62,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,7.84,70,,6.27,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,9.52,
HEPARIN 25000 UNITS  .45% NS  500ML(BB),31032056,CDM,636,RC,J1644,HCPCS,OUTPATIENT,,,167.00,66.80,,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.2,60,,80.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,141.95,85,,113.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,116.9,70,,93.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,32,,42.75,percent of total billed charges,32% of total billed charges,53.44,141.95,
XARELTO 10 MG TABLET,31032058,CDM,250,RC,,,OUTPATIENT,,,11.20,4.48,,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,60,,5.38,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,9.52,85,,7.62,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,7.84,70,,6.27,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,32,,2.86,percent of total billed charges,32% of total billed charges,3.58,9.52,
HEPARIN 12500 UNITS  D5W  250ML,31032060,CDM,636,RC,J1644,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
HEPARIN 5000 UNITS/ML - 1 ML MDV,31032913,CDM,636,RC,J1644,HCPCS,OUTPATIENT,,,6.08,2.43,,,,,,other ,not seperately reimbursable,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.65,60,,2.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,5.17,85,,4.14,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,4.26,70,,3.41,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,1.95,32,,1.56,percent of total billed charges,32% of total billed charges,1.95,5.17,
PROTAMINE SULF INJ 1% 25ML,31033001,CDM,250,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
HEPARIN INJ: 10000 UNITS,31033002,CDM,636,RC,J1644,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
TRANEXAMIC ACID 1000 MG/10 ML,31034002,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
AMICAR INJ 250 MG/ML : 20 ML,31034006,CDM,250,RC,,,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
THROMBIN TOPICAL 5000 UNITS,31034007,CDM,250,RC,,,OUTPATIENT,,,156.00,62.40,,,,,,other ,not seperately reimbursable,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.6,60,,74.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,109.2,70,,87.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,49.92,32,,39.94,percent of total billed charges,32% of total billed charges,49.92,132.6,
GELFOAM SPONGE:12-7 MM,31034008,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
GELFILM 25X50MM:FILM,31034009,CDM,250,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
AMICAR 500MG TAB:500MG,31034010,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
AVITENE SHEET 70X35X1MM,31034012,CDM,250,RC,,,OUTPATIENT,,,318.00,127.20,,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.8,60,,152.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,222.6,70,,178.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,101.76,32,,81.41,percent of total billed charges,32% of total billed charges,101.76,270.3,
AVITENE ENT SHEET:15X15X1,31034013,CDM,250,RC,,,OUTPATIENT,,,243.00,97.20,,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.8,60,,116.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,170.1,70,,136.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,32,,62.21,percent of total billed charges,32% of total billed charges,77.76,206.55,
AVITENE JAR: 1GM,31034014,CDM,250,RC,,,OUTPATIENT,,,344.00,137.60,,,,,,other ,not seperately reimbursable,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.4,60,,165.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,240.8,70,,192.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,110.08,32,,88.06,percent of total billed charges,32% of total billed charges,110.08,292.4,
AVITENE JAR: 5GM,31034015,CDM,250,RC,,,OUTPATIENT,,,1075.00,430.00,,,,,,other ,not seperately reimbursable,344,32,,275.2,percent of total billed charges,32% of total billed charges,344,32,,275.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,645,60,,516,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344,32,,275.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344,32,,275.2,percent of total billed charges,32% of total billed charges,913.75,85,,731,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344,32,,275.2,percent of total billed charges,32% of total billed charges,344,32,,275.2,percent of total billed charges,32% of total billed charges,752.5,70,,602,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,344,32,,275.2,percent of total billed charges,32% of total billed charges,344,32,,275.2,percent of total billed charges,32% of total billed charges,344,913.75,
TROMBIN TOPICAL:10000 UNITS,31034016,CDM,250,RC,,,OUTPATIENT,,,258.00,103.20,,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.8,60,,123.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,180.6,70,,144.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,32,,66.05,percent of total billed charges,32% of total billed charges,82.56,219.3,
HEMABATE 250MCG SDV:250MCG,31034018,CDM,250,RC,,,OUTPATIENT,,,294.00,117.60,,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.4,60,,141.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,205.8,70,,164.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,32,,75.26,percent of total billed charges,32% of total billed charges,94.08,249.9,
GELFOAM LARGE SZ100,31034019,CDM,250,RC,,,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
DOPAMINE SDV 400MG/5ML:400MG,31040004,CDM,636,RC,J1265,HCPCS,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
DOPamine 400 MG/250 ML PREMIXED BAG,31040005,CDM,636,RC,J1265,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
DOPAMINE 800MG IVPB 2B8043:500ML,31040006,CDM,636,RC,J1265,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
DIGOXIN 0.125 MG TABLET,31041001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HYGROTON:25 MG EQ,31041002,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LANOXICAPS:50MCG,31041003,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LANOXICAPS:100MCG,31041005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROPRANOLOL LA CAP:80MG (N/A),31041006,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PROPRANOLOL LA CAP:60MG,31041007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROPRANOLOL 10 MG TABLET,31041008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROPRANOLOL 40MG TAB:40MG,31041009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PRONESTYL CAP:250 MG EQ,31041010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PRONESTYL CAP:375 MG EQ,31041011,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
QUINIDINE TAB:200MG,31041012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
QUINIDINE CAP:300MG,31041013,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
QUINAGLUTE DURA-TAB:5GR EQUIV,31041014,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DIGOXIN 0.5 MG/2 ML AMPULE,31041015,CDM,636,RC,J1160,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
DIGOXIN 0.25 MG TABLET,31041016,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIGOXIN ORAL ELIXIR:0.25MG/5ML,31041017,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DIGOXIN ORAL LIQ 0.125MG/2.5ML:2.5ML,31041018,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
INDERAL 1MG IVP:1MG,31041019,CDM,636,RC,J1800,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
BUMETANIDE 1 MG/4 ML SDV,31041020,CDM,636,RC,J1939,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
PROCAINAMIDE IV: 1GM,31041021,CDM,636,RC,J2690,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
LIDOCAINE 2 GM/D5W 500 ML - PREMIXED BAG,31041022,CDM,636,RC,J2001,HCPCS,OUTPATIENT,,,223.00,89.20,,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.8,60,,107.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,156.1,70,,124.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,189.55,
LIDOCAINE 1GM/250ML:250ML,31041023,CDM,250,RC,,,OUTPATIENT,,,151.00,60.40,,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.6,60,,72.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,105.7,70,,84.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,32,,38.66,percent of total billed charges,32% of total billed charges,48.32,128.35,
QUINIDINE SULF 300MG SA:300MG,31041024,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
FLECAINIDE TAB 50MG:50MG,31041025,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LIDOCAINE 100 MG/5 ML PREFILLED SYRINGE,31041026,CDM,636,RC,J2003,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
MEXILETINE 200MG:200MG,31041027,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SOTALOL 80 MG TABLET,31041028,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DISOPYRAMIDE 100MG:100MG,31041029,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DISOPYRAMIDE 150MG:150MG,31041030,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
BRETYLOL INJ:500 MG/10 ML,31041031,CDM,250,RC,,,OUTPATIENT,,,183.00,73.20,,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.8,60,,87.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,128.1,70,,102.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,155.55,
DOBUTREX INJ:250MG/20 ML,31041032,CDM,636,RC,J1250,HCPCS,OUTPATIENT,,,297.00,118.80,,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.2,60,,142.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,207.9,70,,166.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,32,,76.03,percent of total billed charges,32% of total billed charges,95.04,252.45,
VERAPAMIL 5 MG/2 ML SDV,31041033,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
ACEBUTOLOL CAP : 200MG,31041034,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
INDERAL TAB:80MG,31041035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOBUTAMINE IV 500MG/250ML,31041036,CDM,636,RC,J1250,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
BLOCADREN TAB:10 MG,31041038,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MEXILETINE 150MG:150MG,31041039,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FLECAINIDE TAB 100MG:100MG,31041040,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NIFEDIPINE 10MG CAP:10MG,31041041,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SOTALOL TAB 120MG:120MG,31041043,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VERAPAMIL 80 MG TABLET,31041044,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CALAN TAB:120 MG,31041045,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ATENOLOL 50 MG TABLET,31041046,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ATENOLOL 25 MG TABLET,31041047,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROCAINAMIDE ER 500MG:500MG,31041048,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROCAINAMIDE SR:750MG,31041049,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DILTIAZEM TAB 30MG,31041050,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMIODARONE 200 MG TABLET,31041051,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AMIODARONE 150 MG/3 ML SDV,31041052,CDM,636,RC,J0282,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
TRANDATE 300MG TAB:300MG,31041053,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CORVERT SDV 1MG/10ML:1MG,31041054,CDM,636,RC,J1742,HCPCS,OUTPATIENT,,,980.00,392.00,,,,,,other ,not seperately reimbursable,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,588,60,,470.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,833,85,,666.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,686,70,,548.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,313.6,32,,250.88,percent of total billed charges,32% of total billed charges,313.6,833,
cloNIDine 0.3 MG/DAY PATCH,31041055,CDM,250,RC,,,OUTPATIENT,,,93.00,37.20,,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.8,60,,44.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,65.1,70,,52.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,32,,23.81,percent of total billed charges,32% of total billed charges,29.76,79.05,
VISKEN TAB: 10MG,31041056,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
cloNIDine 0.1 MG/DAY PATCH,31041057,CDM,250,RC,,,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,39.95,
cloNIDine 0.2 MG/DAY PATCH,31041058,CDM,250,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
PINDOLOL TAB 5MG:5MG,31041059,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
INOCOR INJ:100 MG/20 ML,31041060,CDM,250,RC,,,OUTPATIENT,,,316.00,126.40,,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.6,60,,151.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,221.2,70,,176.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,32,,80.9,percent of total billed charges,32% of total billed charges,101.12,268.6,
LABETALOL TAB:200MG,31041061,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TENEX TAB: 2MG,31041062,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LANOXICAPS:200MG,31041063,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CARDENE  TAB: 20MG,31041064,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CARDENE TAB: 30MG,31041065,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CARDENE TAB: 30MG,31041066,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TONOCARD TAB: 400MG,31041067,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MAXZIDE 75/50MG TAB:75/50MG,31041068,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
INDERAL TAB:20 MG EQ,31041069,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
EUDURON:5 MG,31041070,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DYNACIRC 2.5MG : NF- USE NORVASC 5MG,31041071,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DYNACIRC 5MG : NF- USE NORVASC 5MG,31041072,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LABETALOL 100 MG TABLET,31041073,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PROPRANOLOL 20MG TAB:20MG,31041074,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROPRANOLOL 40 MG TAB (N/A),31041076,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMIODARONE 150 MG/D5 100 ML BOLUS - DMH,31041079,CDM,636,RC,J0282,HCPCS,OUTPATIENT,,,115.00,46.00,,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,97.75,
AMIODARONE 450MG/9ML SDV:450MG,31041080,CDM,636,RC,J0282,HCPCS,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
BUMETANIDE 2.5MG/10ML MDV,31041081,CDM,636,RC,,,OUTPATIENT,,,101.00,40.40,,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.6,60,,48.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,70.7,70,,56.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,32,,25.86,percent of total billed charges,32% of total billed charges,32.32,85.85,
AMIODARONE 360MG/200ML DRIP,31041082,CDM,636,RC,J0282,HCPCS,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
TRIAMTERENE/HCTZ 37.5/25:37.5/25,31041086,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
INDERAL TAB:80MG EQUIV,31041136,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LIPITOR 40MG TAB:40MG,31042000,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ATROMID S CAP:500 MG,31042001,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TRICOR TAB:54MG-DISCONTINUED DOSE,31042003,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
TRICOR TAB:160MG-DISCONTINUED DOSE,31042004,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
GEMFIBROZIL TAB:600MG,31042005,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PRAVASTATIN 20 MG TABLET,31042006,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ZOCOR 5MG TAB:5MG,31042007,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
SIMVASTATIN 10 MG TABLET,31042008,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SIMVASTATIN 20 MG TABLET,31042009,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LIPITOR 10MG TAB EQUIV,31042010,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ATORVASTATIN 20 MG TABLET,31042011,CDM,250,RC,,,OUTPATIENT,,,5.25,2.10,,,,,,other ,not seperately reimbursable,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,60,,2.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,4.46,85,,3.57,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,3.68,70,,2.94,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,1.68,32,,1.34,percent of total billed charges,32% of total billed charges,1.68,4.46,
SIMVASTATIN 40 MG TABLET,31042012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
EZETIMIBE 10 MG TABLET,31042013,CDM,250,RC,,,OUTPATIENT,,,14.21,5.68,,,,,,other ,not seperately reimbursable,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.53,60,,6.82,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,12.08,85,,9.66,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,9.95,70,,7.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,4.55,32,,3.64,percent of total billed charges,32% of total billed charges,4.55,12.08,
SIMVASTATIN 80MG TAB: USE 40MG TABS,31042014,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ATORVASTATIN 40MG TAB:40MG,31042015,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TRICOR 48MG:48MG,31042016,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
FENOFIBRATE 145 MG TABLET,31042017,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
OMEGA-3 FISH OIL 1000 MG CAPSULE,31042018,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
"PRAVASTATIN 40 MG n/a, use 2x20mg",31042019,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ATORVASTATIN 10MG TAB,31042020,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
VERAPAMIL ER 120 MG TABLET,31042030,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
METHYLDOPA TAB:250MG,31043001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ATENOLOL IV 5MG/10ML:5MG,31043002,CDM,250,RC,,,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
MONOPRIL 10MG N/F:LISINOPRIL 5MG,31043003,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
HYDRALAZINE TAB 10MG:10MG,31043004,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
hydrALAzine 25 MG TABLET,31043005,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
VERAPAMIL ER 240MG TAB,31043006,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
dilTIAZem ER 180 MG CAPSULE,31043007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
dilTIAZem ER 240 MG CAPSULE,31043008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TIAZAC CAP 360MG: 360MG,31043009,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
APRESAZIDE CAP:25-25,31043010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TIAZAC 300MG:300MG,31043011,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
dilTIAZem ER 120 MG CAPSULE,31043012,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MONOPRIL 20MG N/F:LISINOPRIL 10MG,31043013,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LOSARTAN 25MG TAB,31043014,CDM,250,RC,,,OUTPATIENT,,,2.50,1.00,,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.5,60,,1.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,2.13,85,,1.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,1.75,70,,1.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,2.13,
LOSARTAN 50 MG TABLET,31043015,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AVAPRO 150MG TAB,31043016,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
RESERPINE TAB:0.25 MG,31043017,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HYZAAR TAB: 50/12.5MG,31043018,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
FELODIPINE 5MG : NF- USE NORVASC 5MG,31043019,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
AVAPRO 300MG:300MG,31043020,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
amLODIPine 10 MG TABLET,31043021,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
hydrALAzine 20 MG/ML SDV,31043022,CDM,636,RC,J0360,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,26.52,272,,,fee schedule,272% of BCBS fee schedule,26.52,272,,,fee schedule,272% of BCBS fee schedule,26.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
METHYLDOPA 250MG/5ML IV:250MG,31043023,CDM,636,RC,J0210,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
NIFEdipine ER 30 MG TABLET,31043024,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
NIFEDIPINE ER 60MG TAB:60MG,31043025,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
NITROPRUSSIDE 50MG/2ML,31043026,CDM,250,RC,,,OUTPATIENT,,,1149.00,459.60,,,,,,other ,not seperately reimbursable,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,689.4,60,,551.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,976.65,85,,781.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,804.3,70,,643.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,367.68,32,,294.14,percent of total billed charges,32% of total billed charges,367.68,976.65,
NIFEDIPINE ER 90MG TB:90MG,31043027,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
REGITINE INJ:5MG,31043028,CDM,250,RC,,,OUTPATIENT,,,181.00,72.40,,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.6,60,,86.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,126.7,70,,101.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,32,,46.34,percent of total billed charges,32% of total billed charges,57.92,153.85,
DOXAZOSIN 4 MG TABLET,31043029,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
amLODIPine 5 MG TABLET,31043030,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BREVIBLOC 2500 MG/250 ML PREMIXED BAG,31043031,CDM,250,RC,,,OUTPATIENT,,,614.00,245.60,,,,,,other ,not seperately reimbursable,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.4,60,,294.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,521.9,85,,417.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,429.8,70,,343.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,196.48,32,,157.18,percent of total billed charges,32% of total billed charges,196.48,521.9,
HYPERSTAT IV 15 MG/ML:20 ML,31043032,CDM,636,RC,J1730,HCPCS,OUTPATIENT,,,443.00,177.20,,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.8,60,,212.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,376.55,85,,301.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,310.1,70,,248.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,32,,113.41,percent of total billed charges,32% of total billed charges,141.76,376.55,
cloNIDine 0.1 MG TABLET,31043033,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ENALAPRIL 10mg:N/F- use Lisinopril 10mg,31043034,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MINIPRESS CAP: 1MG,31043035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CLONIDINE TAB: 0.3MG,31043036,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MINIPRESS CAP: 5MG,31043037,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ALDOMET TAB:125 MG,31043038,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METOPROLOL TARTRATE 50 MG TABLET,31043039,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LOTENSIN 10MG N/F: LISINOPRIL 10MG,31043040,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NADOLOL TAB 40MG,31043041,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LOTENSIN 20MG N/F: LISINOPRIL 20MG,31043042,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LISINOPRIL 10 MG TABLET,31043043,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DILTIAZEM TAB 90MG,31043044,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DILTIAZEM 60 MG TABLET,31043045,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CAPTOPRIL TAB:12.5MG,31043046,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CAPTOPRIL TAB:25MG,31043047,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
dilTIAZem 25 MG/5 ML SDV,31043048,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
cloNIDine 0.2 MG TABLET,31043049,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ESMOLOL 100 MG/10 ML SDV,31043050,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
BREVIBLOC AMP: 2500MG/10ML,31043051,CDM,250,RC,,,OUTPATIENT,,,389.00,155.60,,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.4,60,,186.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,330.65,85,,264.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,272.3,70,,217.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,330.65,
CARDIZEM SR CAP:90MG(BAD#-USE TIAZAC),31043052,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CARDIZEM SR CAP:120MG(BAD#-USE TIAZAC),31043053,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
METOPROLOL ER 50 MG TABLET,31043054,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LISINOPRIL 20 MG TABLET,31043055,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CARVEDILOL 3.125 MG TABLET,31043056,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MINIPRESS CAP: 2MG,31043057,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CARVEDILOL 12.5 MG TABLET,31043058,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CARVEDILOL 6.25 MG TABLET,31043059,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
WYTENSIN TAB:4 MG,31043060,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ENALAPRIL 2.5mg- N/F- Use lisinopril 2.5,31043061,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
METOPROLOL TARTRATE 5 MG/5 ML SDV,31043062,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
TERAZOSIN 2MG-N/F:USE DOXAZOSIN 2,31043063,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
TERAZOSIN 1MG N/F:USE DOXAZOSIN,31043064,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TERAZOSIN 5MG N/F:USE DOXAZOSIN 4MG,31043065,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ENALAPRIL 5mg-N/F use Lisinopril 5mg,31043066,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NORMODYNE SYRINGE: 20MG/4ML,31043067,CDM,250,RC,,,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
LABETALOL 100MG/20ML MDV- CHARGED PER MG,31043068,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
DOXAZOSIN 1 MG TABLET,31043069,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ACCUPRIL 10MG N/F: LISINOPRIL 5MG,31043070,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ACCUPRIL 20MG N/F: LISINOPRIL 10MG,31043071,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
TAMSULOSIN 0.4 MG CAPSULE,31043072,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
RAMIPRIL 2.5 MG CAPSULE,31043073,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
RAMIPRIL 5MG CAP:5MG,31043074,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
RAMIPRIL 1.25MG:1.25MG,31043075,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
METOPROLOL-ER TAB 100MG,31043076,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LISINOPRIL 5 MG TABLET,31043077,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BENAZEPRIL 5MG N/F: LISINOPRIL 5MG,31043078,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
METOPROLOL ER 25 MG TABLET,31043079,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
FINASTERIDE 5 MG TABLET,31043080,CDM,636,RC,S0138,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACCUPRIL 5MG N/F: LISINOPRIL 2.5MG,31043081,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ATACAND 16MG:16MG,31043082,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ATACAND 32MG:32MG,31043083,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ENALAPRILAT SDV 2.5MG/2ML IV,31043084,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
DIOVAN 80 MG TABLET,31043085,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DIOVAN 160MG TAB,31043086,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
METOPROLOL TARTRATE 25 MG TABLET,31043087,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ENALAPRIL 20MG-N/F use lisinopril 20mg,31043088,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CAPTOPRIL TAB:50MG,31043089,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOXAZOSIN 2MG:2MG,31043090,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
RAMIPRIL 10MG CAP,31043091,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CARVEDILOL 25 MG TABLET,31043092,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LISINOPRIL 40 MG TABLET,31043093,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BENICAR TAB 20MG:20MG,31043094,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DIOVAN 40MG TAB:40MG,31043095,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
BENICAR 40MG TAB,31043096,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DIOVAN 320MG TAB,31043097,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ENALAPRILAT SDV 1.25MG/ML IV:1.25MG SDV,31043098,CDM,636,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
BENICAR TAB 5MG:5MG,31043099,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LOTREL 5/10 EQUIV:5/10,31043100,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
dilTIAZem 50 MG/10 ML SDV,31043101,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
TEKTURNA TAB 300MG,31043102,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TEKTURNA TAB 150MG:150MG,31043103,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MIDODRINE 2.5 MG TABLET,31043110,CDM,250,RC,,,OUTPATIENT,,,2.00,0.80,,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.2,60,,0.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,1.4,70,,1.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,1.7,
BIDIL 20-37.5 TAB:20-37.5MG,31044006,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
ISOSORBIDE MN 10MG:10MG,31044007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISOSORBIDE MN 20MG:20MG,31044008,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ISORDIL TAB SL:2.5 MG EQUIV,31044009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISORDIL TAB SL:5 MG EQUIV,31044010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISORDIL TAB: 5MG EQ,31044011,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISOSORBIDE DI 10MG:10MG,31044012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISORDIL TEMBIDS TAB:40 MG EQUIV,31044013,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISOSORBIDE DI 20MG TAB,31044014,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NITROBID CAP:2.5MG EQ,31044015,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NTG TAB:0.6 MG 1/100 GR EA,31044016,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET,31044017,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
NTG TAB:0.3 MG 1/200 GR EA,31044018,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NITROLINGUAL SPRAY 0.4MG,31044019,CDM,250,RC,,,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96,40,,76.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,204,
ISOSORBIDE MONONITRATE ER 30 MG TABLET,31044020,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISOSORBIDE MONONITRATE ER 60 MG TABLET,31044021,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NATRECOR 1.5MG SDV:1.5MG,31044022,CDM,636,RC,J2325,HCPCS,OUTPATIENT,,,1406.00,562.40,,,,,,other ,not seperately reimbursable,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,843.6,60,,674.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,1195.1,85,,956.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,984.2,70,,787.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,449.92,32,,359.94,percent of total billed charges,32% of total billed charges,449.92,1195.1,
DIPYRIDAMOLE TAB:25MG,31044023,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PERSANTINE TABLET:50MG EQ,31044024,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AGGRENOX 200-25MG CAP,31044025,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
AMYL NITRATE CAP:0.3 ML,31044027,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
NITRO-BID 2% OINTMENT - 30 GM TUBE,31044028,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
NITRO-BID 2% OINTMENT - 1 GM PACKET,31044029,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NITRO 100MG/250ML-BAD# USE 50MG/250ML,31044030,CDM,250,RC,,,OUTPATIENT,,,205.00,82.00,,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123,60,,98.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,143.5,70,,114.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,174.25,
NITROGLYCERIN 50MG/250ML PREMIXED BOTTLE,31044031,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
RANOLAZINE 500 MG ER TABLET,31044032,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
NITROBID CAP:6.5 MG EQ,31044034,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NTG 0.1MG/HR PATCH,31044035,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
NITROGLYCERIN 0.2 MG/HOUR PATCH,31044036,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
NTG 0.3MG/HR PATCH,31044037,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
NTG 0.4MG/HR  PATCH,31044038,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
NTG 0.6MG/HR  PATCH,31044039,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PERSANTINE TAB:75MG EQUIV,31044041,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MINOXIDIL 2.5 MG TABLET,31044042,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MINOXIDIL TAB 10MG:10MG,31044043,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LITHIUM CARBONATE 300MG,31050001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SPIRITUS FERMENTI:1 OZ,31050005,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SPIRITUS MALTOS HOPS,31050010,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MORPHINE 4 MG/ML PREFILLED SYRINGE,31050020,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
ASCRIPTIN TAB,31051005,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DARVOCET N 100 (PROPXY/APAP) TAB,31051008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CAFFEINE & NA BENZOATE 2ML IV:2ML,31051010,CDM,250,RC,,,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
ACETAMINOPHEN 160MG/5ML INF DROPS,31051011,CDM,250,RC,,,OUTPATIENT,,,8.58,3.43,,,,,,other ,not seperately reimbursable,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.15,60,,4.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,7.29,85,,5.83,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,6.01,70,,4.81,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,2.75,32,,2.2,percent of total billed charges,32% of total billed charges,2.75,7.29,
TYLENOL 80MG MAWY TABS:80MG,31051012,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACETAMINOPHEN 325 MG TABLET,31051014,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
TICLID TAB:250MG,31051015,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ASPIRIN 325 MG ENTERIC COATED TABLET,31051016,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
ASPIRIN 81 MG ENTERIC COATED TABLET,31051017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MIDRIN CAPSULE: EQ,31051018,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
IBUPROFEN 400 MG TABLET,31051019,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ANAPROX TAB : 275 MG,31051022,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ANAPROX DS TAB,31051023,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
IBUPROFEN 800 MG TABLET,31051025,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ULTRACET TAB:TAB,31051026,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
traMADol 50 MG TABLET,31051027,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METHOTREXATE 2.5 MG TABLET,31051028,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
METHOTREXATE 50MG/2ML IM:50MG,31051029,CDM,636,RC,,,OUTPATIENT,,,49.00,19.60,,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
ASPIRIN 325 MG MICRO COATED TABLET,31051033,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
IBUPROFEN INFANT DROPS 40 MG/ML -15 ML,31051034,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MOTRIN CONC INF DROPS 40MG/ML 30ML,31051035,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
INDOCIN:50MG RS,31051036,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
INDOMETHACIN-SR CAP:75MG,31051037,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
INDOMETHACIN 25 MG CAPSULE,31051038,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
IBUPROFEN 200 MG/10 ML - UD CUP,31051039,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HYDROXYCHLOROQUINE 200 MG TABLET,31051040,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
IBUPROFEN 100MG/5ML 120ML:120ML (BULK),31051041,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
IBUPROFEN 100 MG/5 ML - UD CUP,31051042,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
INDOCIN ORAL SUSP 25MG/5ML:25MG,31051043,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TORADOL TAB:10MG,31051044,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MOTRIN CHEWABLE 100MG TAB:100MG,31051045,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACETAMINOPHEN INF DROPS 15ML,31051046,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
FIORINAL TABLETS,31051047,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
RIDAURA 3MG CAPSULE,31051048,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TYLENOL DROPS 80MG/0.8ML 15ML,31051049,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY,31051050,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY,31051051,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY,31051052,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CARISOPRODOL 350MG TAB:350MG,31051053,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ACETAMINOPHEN 1000 MG/100 ML IVPB,31051054,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
ASPIRIN SUPP 300MG,31051055,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ASPIRIN SUPP : 600 MG,31051056,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NAPROXEN 375MG TAB:375MG,31051057,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NAPROSYN TABLET: 250MG,31051058,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
KETOROLAC 60 MG/2 ML SDV,31051059,CDM,636,RC,J1885,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
KETOROLAC 30 MG/ML SDV,31051060,CDM,636,RC,J1885,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
CLINORIL TAB:150 MG,31051061,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CLINORIL TAB:200 MG EQUIV,31051062,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
IBUPROFEN 600 MG TABLET,31051063,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NALBUPHINE 10MG/ML:10MG,31051064,CDM,636,RC,J2300,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
IBUPROFEN 200MG TAB,31051065,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
KETOROLAC 15 MG/ML SDV,31051066,CDM,636,RC,J1885,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
TALWIN 30MG/ML AMP:30MG,31051067,CDM,636,RC,J3070,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
NAPROSYN-EC TAB: 375MG,31051068,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
NAPROSYN-EC TAB: 500MG,31051069,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
NAPROXEN 500MG TAB,31051071,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CELEBREX CAPSULE 200MG,31051072,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
CeleBREX 100 MG CAPSULE,31051073,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
VIOXX TAB 12.5MG:12.5MG,31051074,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
VIOXX TAB 25MG:25MG,31051075,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
REMICADE 100 MG SDV,31051076,CDM,636,RC,J1745,HCPCS,OUTPATIENT,,,598.00,239.20,,44.9,100,,,fee schedule,100% of Aetna fee schedule,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.8,60,,287.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,508.3,85,,406.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,418.6,70,,334.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,191.36,32,,153.09,percent of total billed charges,32% of total billed charges,44.9,508.3,
ORENCIA 250MG SDV:250MG,31051077,CDM,636,RC,J1745,HCPCS,OUTPATIENT,,,1381.00,552.40,,44.9,100,,,fee schedule,100% of Aetna fee schedule,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,828.6,60,,662.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,1173.85,85,,939.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,966.7,70,,773.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,441.92,32,,353.54,percent of total billed charges,32% of total billed charges,44.9,1173.85,
NALFON CAPSULE: 300MG,31051078,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
VIOXX TAB 50MG:50MG,31051079,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
BEXTRA 10MG TAB:10MG,31051080,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
BEXTRA 20MG TAB:20MG,31051081,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ACETAMINOPHEN 500 MG TABLET,31051082,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
REMICADE WASTE 10 MG/ML DOSE,31051083,CDM,636,RC,J1745,HCPCS,OUTPATIENT,,,1125.00,450.00,,44.9,100,,,fee schedule,100% of Aetna fee schedule,360,32,,288,percent of total billed charges,32% of total billed charges,360,32,,288,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,675,60,,540,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,32,,288,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,32,,288,percent of total billed charges,32% of total billed charges,956.25,85,,765,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,32,,288,percent of total billed charges,32% of total billed charges,360,32,,288,percent of total billed charges,32% of total billed charges,787.5,70,,630,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,360,32,,288,percent of total billed charges,32% of total billed charges,360,32,,288,percent of total billed charges,32% of total billed charges,44.9,956.25,
NALBUPHINE 20MG/1ML AMP:20MG,31051084,CDM,636,RC,J2300,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
STADOL 1MG/ML VIAL:1MG,31051085,CDM,636,RC,J0595,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
LORazepam 2 MG/ML SDV,31051086,CDM,636,RC,J2060,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
LORazepam 20 MG/10 ML MDV,31051087,CDM,636,RC,J2060,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
ASPIRIN 81 MG CHEWABLE TABLET,31051088,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
ATIVAN DRIP 20 MG/D5W 100 ML,31051089,CDM,636,RC,J2060,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LORazepam 2 MG/ML - ORAL SOLUTION,31051091,CDM,250,RC,,,OUTPATIENT,,,2.00,0.80,,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.2,60,,0.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,1.4,70,,1.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,1.7,
FELDENE CAP:20 MG,31051093,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
MELOXICAM TAB 15MG:15MG,31051094,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MELOXICAM 7.5 MG TABLET,31051095,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
NAPROXEN NA 220MG TAB:220MG,31051096,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DOLIBID TAB:250 MG,31051097,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ACETAMINOPHEN 650 MG/20.3 ML - UD CUP,31051099,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ACETAMINOPHEN SOLN 160MG/5ML  4OZ,31051100,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
ACETAMINOPHEN 325 MG/10 ML - UD CUP,31051101,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FIORICET 50 MG - 325 MG - 40 MG TABLET,31051103,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
FIORICET #3,31051104,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
KETOROLAC 10MG TAB: TABLET,31051110,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
RELAFEN TAB: 500MG,31051127,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
RELAFEN TAB: 750MG,31051128,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ASA 162MG: 162MG,31051200,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NARCAN INJ:0.4MG/ML-1 ML,31052001,CDM,636,RC,J2310,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
NALOXONE 0.4 MG/ML SDV,31052002,CDM,636,RC,J2310,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
NALOXONE 2 MG/2 ML PREFILLED SYRINGE,31052003,CDM,636,RC,J2310,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
FLUMAZENIL 0.5 MG/5 ML MDV,31052004,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
NARCAN INJ:0.02/ML-2ML,31052005,CDM,636,RC,J2310,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
DILANTIN CAP: 30MG,31053001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PHENYTOIN 100 MG CAPSULE,31053002,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DILANTIN INFATAB 50MG:50MG,31053003,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FOSPHENYTOIN 100MG-PE/2ML:100MG-PE,31053005,CDM,636,RC,Q2009,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
FOSPHENYTOIN 500MG-PE/10ML SDV,31053006,CDM,636,RC,Q2009,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
DO NOT USE0MG/10ML,31053007,CDM,250,RC,,,OUTPATIENT,,,382.00,152.80,,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.2,60,,183.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,267.4,70,,213.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,122.24,32,,97.79,percent of total billed charges,32% of total billed charges,122.24,324.7,
PRIMIDONE 50 MG TABLET,31053008,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PRIMIDONE 250MG TABLET:250MG,31053009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIVALPROEX DR TAB 500MG,31053010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VALPROIC ACID SYRUP 250MG/5ML:250MG,31053011,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DIVALPROEX DR 250 MG TABLET,31053012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DEPAKOTE DR TAB 125MG:125MG,31053013,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PHENYTOIN 250 MG/5 ML SDV,31053014,CDM,636,RC,J1165,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
PHENYTOIN 100MG/2ML IV,31053015,CDM,636,RC,J1165,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
PHENYTOIN 100MG/4ML UD SUSP,31053016,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MAGNESIUM SULFATE 50% (1 GM/2 ML) SDV,31053018,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
ZINC SULFATE 5MG/ML INJ,31053019,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
GABAPENTIN 300 MG CAPSULE,31053020,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GABAPENTIN 100 MG CAPSULE,31053021,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GABAPENTIN 400 MG CAPSULE,31053022,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TOPIRAMATE 25 MG TABLET,31053023,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
KEPPRA 250MG TAB:250MG,31053024,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
levETIRAcetam 500 MG TABLET,31053025,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TOPIRAMATE 200MG TAB:200MG,31053026,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TOPIRAMATE 100MG TAB,31053027,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
GABAPENTIN 600 MG TABLET,31053028,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
GABITRIL 4MG TAB:4MG,31053029,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
VALPROATE SOD SDV 500MG/5ML:500MG,31053030,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
TOPAMAX SPRNKLE 15MG:15MG,31053031,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PREGABALIN 50 MG CAPSULE,31053032,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PREGABALIN 75 MG CAPSULE,31053033,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LEVETIRACETAM 1000MG/10ML SOLN,31053034,CDM,250,RC,,,OUTPATIENT,,,1.13,0.45,,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,60,,0.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.96,85,,0.77,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.79,70,,0.63,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,0.96,
PREGABALIN 25 MG CAP,31053035,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
levETIRAcetam 500 MG/5 ML SDV,31053036,CDM,636,RC,J1953,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
PREGABALIN 100 MG CAPSULE,31053037,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MAGNESIUM SULFATE 2 GM/50 ML - PREMIXED,31053040,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,117.00,46.80,,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.2,60,,56.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,81.9,70,,65.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,99.45,
LAMOTRIGINE 25MG:25MG,31053998,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
lamoTRIgine 100 MG TABLET,31053999,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DESIPRAMINE TAB:75MG,31054004,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DESIPRAMINE TAB:25MG,31054005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DESIPRAMINE TAB:50MG,31054006,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOXEPIN CAP 10MG:10MG,31054007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOXEPIN 25MG CAP:25MG,31054008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOXEPIN 50MG CAP,31054009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FLUOXETINE 10MG:10MG,31054010,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CITALOPRAM HBR 40MG TAB,31054011,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
IMIPRAMINE TAB 25MG:25MG,31054012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TOFRANIL-PM CAP: 75 MG,31054013,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TOFRANIL-PM CAP 150MG,31054014,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
LEXAPRO TAB 10MG:10MG,31054015,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
ETRAFON TAB:2-25,31054016,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CITALOPRAM 20 MG TABLET,31054017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ETRAFON FORTE TAB:4-25,31054018,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
FLUoxetine 20 MG CAPSULE,31054019,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
AMITRIPTYLINE 25 MG TABLET,31054020,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
AMITRIPTYLINE 10 MG TABLET,31054021,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMITRIPTYLINE TAB 50MG,31054022,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AMITRIPTYLINE TAB:75MG,31054023,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PAMELOR CAPSULE: 50MG,31054024,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
buPROPion SR 150 MG TABLET,31054025,CDM,636,RC,S0106,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
BUSPAR TABLET: 5MG,31054026,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
BUSPAR TABLET: 10MG,31054027,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
LIMBITROL TAB:10/25 MG EQUIV,31054028,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LIMBITROL:5/12.5 MG EQUIV,31054029,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
BUPROPION SR 100MG:100MG,31054030,CDM,636,RC,S0106,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
busPIRone 15 MG TABLET,31054031,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
NORTRIPTYLINE CAP:10MG,31054032,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NORTRIPTYLINE 25MG:25MG,31054033,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BUPROPION TAB 75MG:75MG,31054035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VENLAFAXINE 75 MG TABLET,31054036,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
MIRTAZAPINE 15 MG TABLET,31054040,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
MIRTAZAPINE 30 MG ODT,31054041,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
MIRTAZAPINE 45MG:45MG,31054042,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
traZODone 50 MG TABLET,31054045,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
SERTRALINE 50 MG TABLET,31054050,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PARoxetine 20 MG TABLET,31054051,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
EFFEXOR TABLET: 37.5MG,31054052,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SERTRALINE 100MG TAB:100MG,31054053,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VENLAFAXINE ER 75 MG CAPSULE,31054054,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SERZONE 150MG-NON-FORMULARY:150MG,31054055,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
EFFEXOR XR 37.5MG:37.5MG,31054056,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
EFFEXOR-XR 150MG:150MG,31054057,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
NORTRIPTYLINE 75MG:75MG,31054058,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PAXIL CR TAB:12.5MG,31054059,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
VENLAFAXINE TAB 50MG:50MG,31054060,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
DULoxetine 30 MG CAPSULE,31054061,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
DULoxetine 60 MG CAPSULE,31054062,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
ESCITALOPRAM 10MG TAB,31054063,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ESCITALOPRAM 20 MG TABLET,31054064,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
hydrOXYzine HCL 10MG TAB,31055001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
hydROXYzine HCL 25 MG TABLET,31055002,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CHLORDIAZEPOXIDE 25MG:25MG,31055005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LIBRAX CAPSULE: EQUIV,31055006,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MARINOL 5MG CAPSULE:5MG,31055007,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
COMPAZINE TAB:10 MG,31055008,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MARINOL EQ 2.5MG CAP,31055009,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
HALOPERIDOL CONC 2MG/ML:1ML,31055010,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
HALOPERIDOL 1 MG TABLET,31055011,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HALDOL TAB:2 MG,31055012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HALOPERIDOL TAB:5 MG,31055013,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MELLARIL TAB:10MG EQUIV,31055014,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MELLARIL TAB:15MG EQUIV,31055015,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MELLARIL TAB:25MG EQUIV,31055016,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MELLARIL TAB:50MG EQUIV,31055017,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MELLARIL TAB:100MG EQUIV,31055018,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NAVANE CAPSULE:1 MG EQ,31055019,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MELLARIL-S SUSP 25MG/5ML:5ML,31055020,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NAVANE CAPSULE:5 MG EQ,31055021,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CHLOROPROMAZINE 10MG : TAB,31055037,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
COCAINE TOPICAL 4% 4 ML,31055038,CDM,250,RC,,,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
COCAINE TOPICAL 10% 4ML:10%,31055039,CDM,250,RC,,,OUTPATIENT,,,127.00,50.80,,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.2,60,,60.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,88.9,70,,71.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,32,,32.51,percent of total billed charges,32% of total billed charges,40.64,107.95,
TRANXENE CAP:3.75 MG,31055045,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TRANXENE CAP:7.5 MG,31055046,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CHLORDIAZEPOXIDE 5MG: 5MG,31055047,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
hydrOXYzine PAM 25 MG CAPSULE,31055048,CDM,636,RC,Q0177,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VISTARIL CAP:50 MG,31055049,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ONDANSETRON ODT 8MG,31055052,CDM,250,RC,Q0162,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ANZEMET 12.5MG/2ML SDV,31055053,CDM,250,RC,J1260,HCPCS,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
ONDANSETRON 4 MG/2 ML SDV,31055054,CDM,636,RC,J2405,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
PROCHLORPERAZINE SDV 10MG/2ML:10MG,31055055,CDM,636,RC,J0780,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
ONDANSETRON 4 MG ODT,31055056,CDM,250,RC,S0119,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CHLORPROMAZINE IM 25MG/ML,31055057,CDM,636,RC,J3230,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,4.52,272,,,fee schedule,272% of BCBS fee schedule,4.52,272,,,fee schedule,272% of BCBS fee schedule,4.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,4.52,47.6,
THORAZINE INJ:50 MG/2 ML EQUIV,31055058,CDM,636,RC,J3230,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,4.52,272,,,fee schedule,272% of BCBS fee schedule,4.52,272,,,fee schedule,272% of BCBS fee schedule,4.52,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,4.52,51,
DIASTAT 2.5MG RS:2.5MG,31055059,CDM,250,RC,,,OUTPATIENT,,,329.00,131.60,,,,,,other ,not seperately reimbursable,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,197.4,60,,157.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,230.3,70,,184.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,105.28,32,,84.22,percent of total billed charges,32% of total billed charges,105.28,279.65,
PROCHLORPERAZINE SUPP 25MG,31055060,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
VISTARIL EQ INJ:100 MG/2 ML,31055061,CDM,636,RC,J3410,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
diazePAM 10 MG/2 ML,31055062,CDM,636,RC,J3360,HCPCS,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
hydrOXYzine SYRUP 10 MG/5 ML,31055063,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HALDOL CONCENTRATE:15 ML,31055065,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
PROCHLORPERAZINE 5 MG TABLET,31055067,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
ONDANSETRON 4MG ORAL TAB,31055070,CDM,636,RC,S0119,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
chloridiazePOXIDE 10 MG CAPSULE,31055074,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CHLORPROMAZINE TAB 25MG: 25 MG,31055075,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
THORAZINE TAB: 50MG,31055076,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
THORAZINE:100MG,31055077,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIAZEPAM TAB 2MG:2MG,31055078,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
diazePAM 5 MG TABLET,31055079,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
VALIUM TAB:10 MG,31055080,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
HALOPERIDOL SDV 5MG/ML,31055081,CDM,636,RC,J1630,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
NAVANE INJ:10MG/2 ML,31055084,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
PROLIXIN DEC INJ 25MG/1ML:1ML,31055086,CDM,250,RC,,,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,115.6,
LIBRIUM INJ IM:100 MG EQUIV,31055092,CDM,636,RC,J1990,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
COMPAZINE SUPP: 2.5MG,31055094,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
COMPAZINE SUPP: 5MG,31055095,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
COMPAZINE SUPP: 25MG,31055096,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
THORAZINE SUPP: 25MG,31055097,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
THORAZINE SUPP:100MG,31055098,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ONDANSETRON MDV 40MG/20ML:MDV 40MG,31055100,CDM,636,RC,J2405,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
HALDOL TAB:10 MG EQUIV,31055112,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ZYPREXA 5MG TAB:5MG,31055114,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
ZYPREXA 2.5MG TAB:2.5MG,31055115,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
GEODON 60MG:60MG,31055116,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
HALDOL TAB:0.5 MG EQUIV,31055120,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LORazepam 1 MG TABLET,31055121,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LORazepam 0.5 MG TABLET,31055122,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
ALPRAZolam 0.25 MG TABLET,31055137,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,GY,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ALPRAZolam 0.5 MG TABLET,31055138,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ALPRAZolam 1 MG TABLET,31055139,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MIDAZOLAM 5 MG/5 ML SDV,31055142,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
MIDAZOLAM 2 MG/2 ML SDV,31055143,CDM,250,RC,J2250,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
MIDAZOLAM 5 MG/ML SDV,31055144,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
MIDAZOLAM 10 MG/2 ML SDV,31055145,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
MIDAZOLAM 2 MG/2 ML PREFILLED SYRINGE,31055146,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
MIDAZOLAM SYRUP 5MG/2.5ML,31055147,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
MIDAZOLAM 1 MG DOSE,31055148,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,17.50,7.00,,,,,,other ,not seperately reimbursable,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.5,60,,8.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,14.88,85,,11.9,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,12.25,70,,9.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,5.6,32,,4.48,percent of total billed charges,32% of total billed charges,5.6,14.88,
clonazePAM 0.5 MG TABLET,31055151,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CLONAZEPAM 1MG TAB,31055152,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
VISTARIL INJ:25MG EQUIV,31055561,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
hydROXYzine IM 50MG/ML,31055661,CDM,636,RC,J3410,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
hydROXYzine IM 25MG/ML,31055662,CDM,636,RC,J3410,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
AMMONIA AROMATIC CAP:0.4ML,31056009,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
INAPSINE:2 ML,31056019,CDM,636,RC,J1790,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
DROPERIDOL VIAL 5MG/2ML:2 ML,31056020,CDM,636,RC,J1790,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
PROSOM TAB: 1MG,31057010,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ZOLPIDEM 5 MG TABLET,31057011,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ZOLPIDEM 10 MG TABLET,31057012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MELATONIN 3 MG TABLET,31057013,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
RESTORIL CAP:7.5MG,31057038,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TEMAZEPAM 15 MG CAPSULE,31057039,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
RESTORIL CAP: 30MG,31057040,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
HALCION TAB:0.25MG,31057042,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROSOM TAB:2MG,31057085,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
FIORINAL CAP NO.3,31058002,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MORPHINE EXTENDED RELEASE 15 MG TABLET,31058010,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MORPHINE 100MG ER TAB:100MG,31058025,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MORPHINE IMMEDIATE RELEASE 15 MG TABLET,31058026,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ORAMORPH-SR 15MG TAB:15MG,31058027,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MORPHINE SULF ER TABS 60MG,31058028,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
MS CONTIN TAB 30MG,31058029,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MEPERIDINE TAB:50MG,31058030,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
METHADONE 10 MG TABLET,31058031,CDM,636,RC,S0109,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MEPERIDINE LIQ 50MG/5ML:5ML,31058032,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DEMEROL INJ:25 MG/1ML,31058037,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
DEMEROL INJ 50 MG/1 ML,31058038,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
DEMEROL INJ:75 MG/1ML,31058039,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
DEMEROL-PCA,31058040,CDM,259,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
PHENobarbital 32.4 MG TABLET,31058045,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PHENOBARBITAL TAB:15MG,31058046,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PHENOBARBITAL TAB:30MG,31058047,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
DEMEROL INJ:100 MG/1ML,31058048,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
ACETAMINOPHEN/COD 300 MG/30 MG TABLET,31058050,CDM,250,RC,,,OUTPATIENT,,,2.00,0.80,,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.2,60,,0.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,1.4,70,,1.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,32,,0.51,percent of total billed charges,32% of total billed charges,0.64,1.7,
HYDROmorphone 2 MG/ML PREFILLED SYRINGE,31058054,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
PHENOBARBITAL TABLET 60MG,31058055,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PENTOTHAL:500MG,31058066,CDM,250,RC,,,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
BREVITAL INJ:500MG,31058067,CDM,250,RC,,,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
BELLADONNA/OPIUM RS 30-16MG,31058069,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
B & O SUPP:16 A,31058070,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
PHENOBARBITAL TABLET: 100MG,31058072,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PHENOBARBITAL 97.2MG:97.2MG,31058073,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PHENOBARBITAL INJ:130MG/1ML,31058074,CDM,636,RC,J2560,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.9,272,,,fee schedule,272% of BCBS fee schedule,13.9,272,,,fee schedule,272% of BCBS fee schedule,13.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,13.9,42.5,
SECOBARBITAL IV: 100MG,31058075,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
MORPHINE SULF INJ:15MG/1ML,31058079,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
MORPHINE 10MG/10ML PF:AMP,31058080,CDM,636,RC,J2274,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
PHENOBARB ELIX 30MG/7.5ML:30MG,31058081,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CHLORAL HYDRATE SYRUP:10ML,31058082,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SUFENTANIL 100MCG/2ML AMP:100MCG,31058083,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
ALFENTA AMP : 2 ML,31058084,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
SUFENTA AMP:1ML,31058085,CDM,250,RC,,,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,96.05,
PHENOBARBITAL:30MG 7.5ML EL,31058100,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
fentaNYL 250MCG/5ML  AMPULE,31058104,CDM,636,RC,J3010,HCPCS,OUTPATIENT,,,64.00,25.60,,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,60,,30.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,44.8,70,,35.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,32,,16.38,percent of total billed charges,32% of total billed charges,20.48,54.4,
APAP/CODEINE ELIXIR 12MG/5ML,31058108,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
APAP/CODEINE ELIXIR 36MG/15ML:15ML,31058109,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
APAP/CODEINE ELIXIR 24MG/10ML,31058110,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
MORPHINE 250 MG/10 ML SDV,31058118,CDM,636,RC,J2274,HCPCS,OUTPATIENT,,,16.41,6.56,,,,,,other ,not seperately reimbursable,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.85,60,,7.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,13.95,85,,11.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,11.49,70,,9.19,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,5.25,32,,4.2,percent of total billed charges,32% of total billed charges,5.25,13.95,
oxyCODONE 15 MG TABLET,31058119,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
oxyCODONE/APAP 10 MG/325 MG TABLET,31058120,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
MEP/PROMETH 50/25MG CAPS:,31058121,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
oxyCODONE 5 MG TABLET,31058122,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
OXYCONTIN 80MG TAB,31058123,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
OxyCONTIN 10 MG TABLET,31058124,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
OXYCONTIN 20MG TAB,31058125,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
OXYCONTIN 40MG TAB,31058126,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
OXYCODONE/APAP 7.5/325MG TAB,31058127,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ROXICET 5/325 5ML UD:5ML,31058128,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
oxyCODONE/APAP 5 MG/325 MG TABLET,31058129,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MORPHINE ORAL LIQUID 10 MG/0.5 ML,31058130,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
HYDROMORPHONE 2MG TAB-bad #-USE 31058151,31058131,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
MORPHINE ORAL LIQUID 20 MG/1 ML,31058132,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
ROXICODONE 5MG/5ML:5ML UD,31058133,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
MORPHINE 10 MG/ML PREFILLED SYRINGE,31058134,CDM,636,RC,J2274,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
HYDROmorphone 1 MG/ML PREFILLED SYRINGE,31058135,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
MORPHINE PCA 30 MG/30 ML,31058136,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,132.00,52.80,,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,60,,63.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,92.4,70,,73.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,32,,33.79,percent of total billed charges,32% of total billed charges,42.24,112.2,
MORPHINE 2 MG/ML PREFILLED SYRINGE,31058137,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
fentaNYL 100 MCG/2 ML AMPULE,31058138,CDM,636,RC,J3010,HCPCS,OUTPATIENT,,,5.70,2.28,,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.42,60,,2.74,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,4.85,85,,3.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,3.99,70,,3.19,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,4.85,
OXYDOSE 20MG/ML 30ML:30ML,31058139,CDM,250,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
HYDROCODONE/APAP 5/500(BAD-USE 31058148),31058140,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CHLORAL HYDRATE CAP: 500MG,31058141,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DILAUDID 10 MG/10 ML PCA,31058142,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,96.9,
HYDROmorphone 4 MG/ML PREFILLED SYRINGE,31058143,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
HYDROmorphone 10 MG/ML SDV,31058144,CDM,636,RC,J1170,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
CHLORAL HYDRATE:650MG RS,31058145,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
MORPHINE 100MG/10ML MDV,31058146,CDM,636,RC,J2274,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MORPHINE 50MG/ML 20ML SDV:1000MG,31058147,CDM,250,RC,J2274,HCPCS,OUTPATIENT,,,84.00,33.60,,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,60,,40.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,58.8,70,,47.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,32,,21.5,percent of total billed charges,32% of total billed charges,26.88,71.4,
HYDROcodone/APAP 5/325 MG TABLET,31058148,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HYDROMORPHONE TAB: 4MG,31058149,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
DURAMORPH 10 MG/10 ML PF SDV,31058150,CDM,636,RC,J2274,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
HYDROmorphone 2 MG TABLET,31058151,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
HYDROmorphone 0.5 MG/0.5 ML SYRINGE,31058152,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
PHENobarbital INJ: 65MG,31058155,CDM,636,RC,J2560,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,13.9,272,,,fee schedule,272% of BCBS fee schedule,13.9,272,,,fee schedule,272% of BCBS fee schedule,13.9,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,13.9,40.8,
HYDROCOD/APAP 5-217MG/10ML,31058161,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HYDROcodone/APAP 2.5MG-108MG/5 ML UD CUP,31058162,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
HYDROCODONE/APAP 7.5/(BAD-USE 31058165),31058163,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HYDROcodone/APAP 10/325 MG TABLET,31058164,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
HYDROcodone/APAP 7.5/325 MG TABLET,31058165,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
fentaNYL 25 MCG/HOUR PATCH,31058171,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
MORPHINE ORAL SOLN 2MG/1ML:1ML,31058175,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
MORPHINE ORAL LIQ 1MG/1ML:1ML,31058180,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
fentaNYL 50 MCG/HOUR PATCH,31058189,CDM,250,RC,,,OUTPATIENT,,,20.79,8.32,,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.47,60,,9.98,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,17.67,85,,14.14,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,14.55,70,,11.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,17.67,
fentaNYL 100 MCG/HOUR PATCH,31058190,CDM,250,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
fentaNYL 75 MCG/HOUR PATCH,31058191,CDM,250,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
SERTRALINE 25 MG TABLET,31058192,CDM,250,RC,,,OUTPATIENT,,,5.43,2.17,,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.26,60,,2.61,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,4.62,85,,3.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,3.8,70,,3.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,1.74,4.62,
HYDROCOD/APAP SOLN 10/325MG15ML :1ML,31058240,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CLINDAMYCIN 600 MG/NS 50 ML - BAXTER PM,31059990,CDM,250,RC,J0737,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CLINDAMYCIN 900 MG/NS 50 ML - BAXTER PM,31059991,CDM,250,RC,J0737,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
CLINDAMYCIN 600 MG/D5 50 ML - BAXTER PM,31059992,CDM,250,RC,J0737,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CLINDAMYCIN 900 MG/D5 50 ML - BAXTER PM,31059993,CDM,250,RC,J0737,HCPCS,OUTPATIENT,,,13.23,5.29,,,,,,other ,not seperately reimbursable,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.94,60,,6.35,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,11.25,85,,9,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,9.26,70,,7.41,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,4.23,32,,3.38,percent of total billed charges,32% of total billed charges,4.23,11.25,
MORPHINE 10 MG/ML SDV,31059995,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
INSULIN DRIP - 100U/100 ML NS - DMH,31060009,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,55.00,22.00,,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
dilTIAZem DRIP 125 MG/NS 125 ML - DMH,31060012,CDM,250,RC,J3490,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
INTRALIPID 20% 250 ML BAG W/ TUBING,31060020,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
PHENYTOIN 100MG/NS 50ML IVPB:50ML,31060021,CDM,636,RC,J1165,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
NITROPRUSSIDE 50 MG/D5W 250 ML,31060022,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
PRIMAXIN (Brand) 500MG/NS 100ML,31060023,CDM,636,RC,J0743,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ceFAZolin 2 GM/D5W 50 ML - PREMIXED,31060028,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,41.20,16.48,,,,,,other ,not seperately reimbursable,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.72,60,,19.78,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,35.02,85,,28.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,28.84,70,,23.07,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,13.18,32,,10.54,percent of total billed charges,32% of total billed charges,13.18,35.02,
PRIMAXIN EQ 500MG/NS 100ML IVPB,31060029,CDM,636,RC,J0743,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
CEFAZOLIN 1GM/DW 50ML DPX,31060031,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
PRIMAXIN EQ 250MG/NS 100ML IVPB,31060032,CDM,636,RC,J0743,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
VANCOMYCIN 125 MG/5 ML - ORAL SOLUTION,31060035,CDM,636,RC,J3370,HCPCS,OUTPATIENT,,,15.00,6.00,,2.61,100,,,fee schedule,100% of Aetna fee schedule,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,2.61,12.75,
LABETALOL 300MG/NS 150ML DRIP:300MG,31060041,CDM,250,RC,,,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,102,
DECADRON OPTH OINT:1/8OZ EQ,31061004,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
NEOSPORIN OPTH OINT: 1/8 OZ EQ,31061005,CDM,250,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
CORTISPORIN OPTH OINT: 1/8 OZ,31061007,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
ERYTHROMYCIN 0.5% EYE OINTMENT - 3.5 GM,31061008,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
NEODECADRON OPH OINT:1/8OZ,31061010,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
PILOPINE 4% GEL,31061011,CDM,250,RC,,,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
CYCLOGYL 1% OPTH DROP: 15ML,31061012,CDM,250,RC,,,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
MIOCHOL OPTH INJ:2ML,31061014,CDM,250,RC,,,OUTPATIENT,,,159.00,63.60,,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.4,60,,76.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,111.3,70,,89.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,32,,40.7,percent of total billed charges,32% of total billed charges,50.88,135.15,
PONTOCAINE OPTH OINT: 1/8 OZ EQ,31061015,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
TIMOPTIC 0.5%: 2.5 ML,31061016,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
TETRACAINE 0.5%:15 ML,31061017,CDM,250,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
GENTAMICIN OPHTH OINT 3.5GM,31061018,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
MAXITROL OINTMENT,31061019,CDM,250,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
OPTHALMIC OINT (LACRILUBE),31061020,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
CYCLOPENTOLATE 1% OPTH DOSE,31061021,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
LIVOSTIN 0.05% 5ML:5ML,31061022,CDM,250,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
BETOPTIC 0.25%:2.5MLS,31061023,CDM,250,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
TERRAMYCIN OPTH OINT: 1/8 OZ,31061024,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
BSS:15ML,31061025,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
BSS:500 ML,31061026,CDM,250,RC,,,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
CHLOROMYCETIN OPH OINT:1/8 OZ,31061027,CDM,250,RC,,,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
SULFACETAMIDE OPHTH SOLN 10% 15ML:15ML,31061029,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
BLEPH-10 OPTH SOL: 5ML,31061030,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
BLEPH-10 OPTH OINT: 3.5GM,31061031,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
MIOSTAT:1.5 ML,31061032,CDM,250,RC,,,OUTPATIENT,,,191.00,76.40,,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.6,60,,91.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,162.35,
SYNVISC 1MG/0.125/ML DOS:1MG,31061033,CDM,636,RC,J7325,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
ASTELIN NASAL SP 30ML:30ML,31061035,CDM,250,RC,,,OUTPATIENT,,,163.00,65.20,,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,60,,78.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,114.1,70,,91.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,138.55,
SPIRIVA HANDIHALER 18 MCG CAPULES,31061036,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
HEALON SYR: 0.85ML,31061037,CDM,250,RC,,,OUTPATIENT,,,604.00,241.60,,,,,,other ,not seperately reimbursable,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362.4,60,,289.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,513.4,85,,410.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,422.8,70,,338.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,193.28,32,,154.62,percent of total billed charges,32% of total billed charges,193.28,513.4,
PROPARACAINE OPHTH DOSE,31061038,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
ATROVENT HFA MDI:MDI,31061039,CDM,250,RC,,,OUTPATIENT,,,513.00,205.20,,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.8,60,,246.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,359.1,70,,287.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,436.05,
INTAL MDI 14GM:14GM,31061040,CDM,250,RC,,,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,150.45,
REV EYES OPHTH DROPS,31061041,CDM,250,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
VANCENASE SPRAY,31061042,CDM,250,RC,,,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,127.5,
IOPIDINE DOSE,31061043,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
APRACLONIDINE 0.5% OPTH DOSE,31061046,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
PILOCARPINE 2% DROPS: 2ML,31061047,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
PILOCARPINE 1% OPTH DOSE,31061048,CDM,250,RC,,,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
PILOCARPINE OPTH 4%: 2ML,31061049,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
PONTOCAINE OPTH 0.5%:15 ML EQ,31061050,CDM,250,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
TETRACAINE 0.5% 0.6ML,31061051,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
REFRESH PLUS,31061052,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
ARTIFICIAL TEARS EYE DROPS 15 ML BOTTLE,31061053,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ALPHAGAN 0.2% OPHTH SOLN:5ML,31061054,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
ALPHAGAN-P 0.15% OPHTH SOL 5ML:5ML,31061055,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
VANOCIDIN OPTH: 5ML,31061056,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
VASOCON OPTH SOL: 15ML,31061057,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
PATANOL 0.1% OPHTH SOL:,31061058,CDM,250,RC,,,OUTPATIENT,,,197.00,78.80,,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.2,60,,94.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,137.9,70,,110.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,32,,50.43,percent of total billed charges,32% of total billed charges,63.04,167.45,
NAPHCON-A OPHTH SOLN 15ML:15ML,31061059,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
TETRAHYDROLOZINE 0.05% EYE DROPS - 15 ML,31061060,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
OPTIVAR 0.05% OPHTH GTT 6ML:6ML,31061061,CDM,250,RC,,,OUTPATIENT,,,195.00,78.00,,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117,60,,93.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,165.75,
REFRESH CELLUVISC EYE GEL - 0.4 ML,31061064,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
LACRIL OPTH SOL: 15ML,31061065,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
NEO-SYNEPHRINE 2.5% OPTH SOL,31061066,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
ISOPTO CARBACHOL 3%:15ML EQUIV,31061067,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
ISOPTO CARPINE 2%:15ML EQUIV,31061068,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
PILOCARPINE HCL 6% OPHTH:15ML,31061069,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
NEOSYNEPHRINE VISCOUS 10%,31061070,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
ATROPINE 1% OPHTHALMIC DROPS - 5ML BTL,31061071,CDM,250,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
PHENYLEPHRINE 2.5% OPHTH SOLN 3 ML,31061080,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
TROPICAMIDE 1% OPHTH SOLN 2ML,31061082,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
COSOPT OPHTH SOLN 10ML,31061084,CDM,250,RC,,,OUTPATIENT,,,313.00,125.20,,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.8,60,,150.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,219.1,70,,175.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,266.05,
NEOMY/POLY B/DEXAMETH OPHTH OINT 3.5GM,31061086,CDM,250,RC,,,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
PILOCARPINE 4% OPHTH SOLN,31061088,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
NEOSPORIN OPTH DROPS: 10ML EQ,31061094,CDM,250,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
NEOSPORIN GU EQ IRR 1ML,31061095,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
OCUFLOX OPTH DOSE,31061101,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CIPROFLOXACIN 0.3% EYE DROPS - 2.5 ML,31061102,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
CILOXAN OPTH DROP:2.5ML,31061103,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
CHLOROMYCETIN OPH SOL:15ML,31061104,CDM,250,RC,,,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
NATACYN 5% OPTH: 15ML,31061105,CDM,250,RC,,,OUTPATIENT,,,372.00,148.80,,,,,,other ,not seperately reimbursable,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.2,60,,178.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,260.4,70,,208.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,119.04,32,,95.23,percent of total billed charges,32% of total billed charges,119.04,316.2,
NEOMYCN/POLYMXN/HC OPHTH SUSP DOSE,31061106,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
VIROPTIC OPTH SOL: 8ML,31061107,CDM,250,RC,,,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,147.05,
OFLOXACIN 0.3% OPHTH SOLN 5ML,31061108,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
OFLOXACIN OTIC SOL 5ML,31061109,CDM,250,RC,,,OUTPATIENT,,,113.00,45.20,,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.8,60,,54.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,79.1,70,,63.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,32,,28.93,percent of total billed charges,32% of total billed charges,36.16,96.05,
CILOXAN OPHTH OINT 4GM:4GM,31061110,CDM,250,RC,,,OUTPATIENT,,,163.00,65.20,,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,60,,78.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,114.1,70,,91.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,138.55,
NEOMYC/POLYMYX/DEX OPHTH SUSP:5ML,31061111,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
VIGAMOX OPHTH SOLN:3ML,31061112,CDM,250,RC,,,OUTPATIENT,,,137.00,54.80,,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,116.45,
BESIVANCE 0.6% OPTH DOSE,31061113,CDM,250,RC,,,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
ZYMAR DOSE:DOSE,31061114,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
ZYMAR 0.3% OPHTH DROPS:5ML,31061115,CDM,250,RC,,,OUTPATIENT,,,133.00,53.20,,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.8,60,,63.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,113.05,
NEOMYCN/POLYMXN/HC OPH SUSP 7.5ML:7.5ML,31061116,CDM,250,RC,,,OUTPATIENT,,,160.00,64.00,,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
TOBRADEX 0.3-0.1% OPTH OINT 3.5 GM,31061117,CDM,250,RC,,,OUTPATIENT,,,205.16,82.06,,,,,,other ,not seperately reimbursable,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.1,60,,98.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,174.39,85,,139.51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,143.61,70,,114.89,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,65.65,32,,52.52,percent of total billed charges,32% of total billed charges,65.65,174.39,
ZYMAXID 0.5% OPHTH DROPS:2.5ML,31061118,CDM,250,RC,,,OUTPATIENT,,,160.00,64.00,,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,60,,76.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,112,70,,89.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,32,,40.96,percent of total billed charges,32% of total billed charges,51.2,136,
ZYMAXID 0.5% DOSE:DOSE,31061119,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
VIGAMOX 0.5% OPHTHALMIC SOLUTION - 3 ML,31061120,CDM,250,RC,,,OUTPATIENT,,,158.48,63.39,,,,,,other ,not seperately reimbursable,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.09,60,,76.07,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,134.71,85,,107.77,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,110.94,70,,88.75,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,50.71,32,,40.57,percent of total billed charges,32% of total billed charges,50.71,134.71,
LIDOCAINE 1%/PHENYLEPHRINE 1.5% ML,31061121,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
TOBRAMYCIN 0.3% OPHTH SOLUTION - 5 ML,31061122,CDM,250,RC,,,OUTPATIENT,,,47.00,18.80,,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,60,,22.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,32.9,70,,26.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,32,,12.03,percent of total billed charges,32% of total billed charges,15.04,39.95,
GENTAMICIN 0.3 % OPHTHALMIC SOLN - 5 ML,31061123,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
FORT GENT EYE GTT:5ML,31061124,CDM,250,RC,,,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
FORTIFIED TOBREX OPTH DROPS,31061125,CDM,250,RC,,,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,150.45,
FORT VANCOMYCIN GTT: 15ML,31061126,CDM,250,RC,,,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,126.65,
SULAMYD SOD OPTH 10%: 15ML,31061129,CDM,250,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
FORT CEFAZOLIN EYE GTT,31061130,CDM,250,RC,,,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
DECADRON OPTH SOL 0.1%: 5ML,31061133,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
LATANOPROST 0.005% EYE DROPS -2.5 ML BTL,31061136,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
LUMIGAN O.03% 2.5ML:2.5ML,31061137,CDM,250,RC,,,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,147.05,
XALATAN (USE LATANOPROST),31061138,CDM,250,RC,,,OUTPATIENT,,,173.00,69.20,,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.8,60,,83.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,121.1,70,,96.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,32,,44.29,percent of total billed charges,32% of total billed charges,55.36,147.05,
TRUSOPT 2% OPTH: 5ML,31061139,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
TIMOLOL 0.25%: 5 ML,31061140,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
TIMOLOL OPTH GTTS 0.5%: 5ML,31061141,CDM,250,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
SULAMYD SOD OPTH 10%: 5ML,31061142,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
TIMOPTIC XE:2.5ML,31061143,CDM,250,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
LACRILUBE OPTH OINT 1/8 OZ EQ,31061144,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
LACRILUBE:UD 0.7 G,31061145,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
POLYMYXIN/TRIMETHOPRIM OPHTH SOLN,31061146,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ISOPTOHOMATROPINE 2%:EQUIV,31061158,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
EYE WASH/IRRIGATION - 118 ML BOTTLE,31061159,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
MYDRIACYL 1% OPTH:3ML,31061160,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
TROPICAMIDE 1% OPTH DOSE,31061161,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
MURO-128 5% OPHTH OINT:3.5GM,31061163,CDM,250,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
MURO OPTH DROPS: 128,31061164,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
PHENYLEPHRINE 2.5% OPTH DOSE,31061165,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
OCUFEN OPTH GTTS:2.5ML,31061166,CDM,250,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
VOLTAREN OPTH DOSE,31061167,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DICLOFENAC 0.1% OPTH SOL:5ML,31061168,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
KETOROLAC 0.5% OPTH DOSE,31061169,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
ACULAR LS 0.4% OPHTH SOLN:5ML,31061170,CDM,250,RC,,,OUTPATIENT,,,183.00,73.20,,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.8,60,,87.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,128.1,70,,102.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,155.55,
OCUFEN GTTS:DOSE,31061175,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
BETADINE 5% OPTH 30 ML,31061179,CDM,250,RC,,,OUTPATIENT,,,14.26,5.70,,,,,,other ,not seperately reimbursable,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.56,60,,6.85,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,12.12,85,,9.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,9.98,70,,7.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,4.56,32,,3.65,percent of total billed charges,32% of total billed charges,4.56,12.12,
SULFACETAMIDE/PREDNIS 10%/0.25% 10ML,31061180,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
TETRACAINE 0.5% OPHTH SOLN 15ML,31061182,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
TIMOLOL 0.5% OPHTH SOLN 10ML,31061184,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
TIMOLOL OCUDOSE 0.5% 0.2ML,31061210,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
RE BENZOTIC 20% OTIC SOLN:15ML,31062003,CDM,250,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
prednisoLONE ACETATE 1% OPTH DOSE,31062004,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
AMERICAINE OTIC:BAD# USE 31062003,31062005,CDM,250,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.8,40,,23.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
ANTIPYRINE/BCAIN OTIC DOSE,31062006,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PRED FORTE 10ML:10ML,31062007,CDM,250,RC,,,OUTPATIENT,,,164.00,65.60,,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,60,,78.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,114.8,70,,91.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,32,,41.98,percent of total billed charges,32% of total billed charges,52.48,139.4,
PRED G OPTH DROPS 5 ML,31062008,CDM,250,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
VEXOL 1%:5ML,31062009,CDM,250,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
FML OPTH DROPS: 5ML,31062010,CDM,250,RC,,,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,30,40,,24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
TRYPAN BLUE OPHTH DROP:DOSE,31062011,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.6,40,,17.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
TRYPAN BLUE 0.5 ML SYRINGE,31062012,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
COLY MYCIN S OTIC SUSP 5ML EQ,31062020,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.6,40,,33.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
CERUMENEX OTIC:6ML,31062021,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
CORTISPORIN OTIC SUSP - 10 ML,31062022,CDM,250,RC,,,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,62.05,
CIPRO HC OTIC SUSP:(10ML),31062023,CDM,250,RC,,,OUTPATIENT,,,315.00,126.00,,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,60,,151.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,267.75,
ACETASOL-HC OTIC SOLN:10ML,31062024,CDM,250,RC,,,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,32.8,40,,26.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
CIPRODEX OTIC SUSP 8ML BOTTLE,31062025,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
DEBROX EAR WAX REMOVAL DROPS - 15 ML BTL,31062026,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
ACETIC ACID OTIC SOLN 2%:15ML,31062027,CDM,250,RC,,,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
EAR WAX REMOVAL DROPS 15ML:15ML,31062028,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CIPRODEX OTIC SUSPENSION - 7.5 ML BOTTLE,31062029,CDM,250,RC,,,OUTPATIENT,,,141.00,56.40,,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,56.4,40,,45.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,119.85,
TREAGAN OTIC SOLN 14ML,31062030,CDM,250,RC,,,OUTPATIENT,,,204.00,81.60,,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.4,60,,97.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,81.6,40,,65.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,142.8,70,,114.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,32,,52.22,percent of total billed charges,32% of total billed charges,65.28,173.4,
PHENYLEPHRINE 1% NASAL SPRAY - 15 ML,31063001,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
NEO-SYNEPHRINE 0.5% NASAL SPRAY - 15 ML,31063002,CDM,250,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
PHENYLEPHRINE 0.25% NASAL DR 30ML:30ML,31063003,CDM,250,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
PHENYLEPHRINE 0.125% NASAL DROPS - 15 ML,31063004,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
AFRIN- -USE GENASAL SPRAY,31063008,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
OXYMETAZOLINE 0.05% NASAL SPRAY - 30 ML,31063009,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
SALINE NASAL DROPS - PEDIATRIC,31063010,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
NASALIDE : NF -USE FLONASE,31063011,CDM,250,RC,,,OUTPATIENT,,,120.00,48.00,,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,60,,57.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,48,40,,38.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,84,70,,67.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,32,,30.72,percent of total billed charges,32% of total billed charges,38.4,102,
NASAL SALINE SPRAY (ADULT): SOL,31063012,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
NORMAL SALINE NOSE DROPS,31063013,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
CHLORASEPTIC SPRAY:6OZ,31064006,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
CEPACOL ANESTHETIC LOZ,31064007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CEPASTAT ANESTHETIC LOZ,31064008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ISOPTO CARPINE 0.5%:15ML EQUI,31066156,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.6,40,,17.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
METOCLOPRAMIDE TAB 5MG,31070000,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CHARCOAL TABLET 250MG:250MG,31070001,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CYTOTEC TAB:100MCG,31070002,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
AQUEOUS CHARCOAL 25GM-120ML,31070003,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
MYLICON CHEW TAB 40MG EQUIV,31070004,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SIMETHICONE DROPS 40 MG/0.6 ML - 30 ML,31070005,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
TAGAMET TAB 300MG:NF USE PEPCID 20MG,31070006,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SIMETHICONE 125MG TAB:125MG,31070007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METOCLOPRAMIDE 10 MG/2 ML SDV,31070008,CDM,636,RC,J2765,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
TAGAMET TAB 200MG:NF USE PEPCID 20MG,31070009,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ZELNORM 6MG TAB:6MG,31070010,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ACTIVATED CHARCOAL/SORBITOL 50 GM/240 ML,31070011,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
METOCLOPRAMIDE 10 MG TABLET,31070012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUCRALFATE 1 GM TABLET,31070013,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SIMETHICONE 80 MG TABLET,31070014,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CYANIDE ANTIDOTE KIT,31070015,CDM,250,RC,,,OUTPATIENT,,,576.00,230.40,,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.6,60,,276.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,489.6,85,,391.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,403.2,70,,322.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,489.6,
ZANTAC IV: NF-USE PEPCID 20MG IV,31070016,CDM,250,RC,,,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
ZANTAC SYRUP 15MG/1ML DOSE,31070017,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
ZANTAC 150MG TAB:NF-USE PEPCID 20MG,31070018,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
MISOPROSTOL 200MCG TAB:200MCG,31070019,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METOCLOPRAMIDE 10MG/10ML SYRUP:10ML,31070020,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ZANTAC 50MG/2ml SDV:50mg,31070021,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
FAMOTIDINE 20 MG TABLET,31070022,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FAMOTIDINE 40 MG TABLET,31070023,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ZANTAC:150MG/6ML-NF USE PEPCID 20MG,31070024,CDM,250,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
PROPULSID 10MG,31070025,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
SUCRALFATE 1 GM/10 ML - UD CUP,31070026,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FAMOTIDINE 20MG/50ML IVPB,31070027,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
FAMOTIDINE 20 MG/2 ML SDV,31070028,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
FAMOTIDINE 40 MG/4 ML SDV,31070029,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
TAGAMET TAB 400MG:NF USE PEPCID 40MG,31070030,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
OMEPRAZOLE 20 MG CAPSULE,31070031,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
PROPULSID:10MG/10ML DOSE,31070032,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
URSODIOL 300MG CAP:300MG,31070033,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CISAPRIDE TABLET: 20MG,31070034,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
PREVACID 15MG CAP:15MG,31070035,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
PREVACID 30MG CAP:30MG,31070036,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
OMEPRAZOLE 40 MG CAPSULE,31070037,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PREVACID GRANULES 30MG:PKT,31070038,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
PROTONIX 40MG,31070040,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
PANTOPRAZOLE 40 MG IV,31070042,CDM,250,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
PROTONIX 20MG-NF USE NEXIUM 40MG,31070043,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
PREVACID IV 30MG:30MG,31070044,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
PREVACID 30 MG SOLUTAB,31070045,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
NexIUM 40 MG IV,31070046,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
NEXIUM CAP 40MG:40MG,31070047,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
NEXIUM CAP 20MG:20MG,31070048,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PREVACID SOLUTAB 15MG:15MG,31070049,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
FAMOTIDINE 20MG/NS 10ML IV PUSH,31070050,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
FAMOTIDINE 40MG/NS 10ML,31070051,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
AXID 15MG/ML ORAL SOLUTION:15MG/ML,31070052,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
RANITIDINE 10MG/NS 10ML IVP:10MG,31070054,CDM,636,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
RANITIDINE 50MG INJ :SDV,31070055,CDM,636,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
ACTIVATED CHARCOAL SUSP 25 GM/120 ML,31070070,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
SUCRALFATE 1GM/10ML (BULK),31070072,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MYLANTA:5 OZ BOTTLE EQUIV,31071006,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
RIOPAN SUSPENSION 12OZ,31071007,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
BICITRA:15ML,31071008,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
UROCIT-K 1080MG:1080,31071009,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GAVISCON FOAMTABS,31071012,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MYLANTA TAB: EQUIV,31071017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MYLANTA II:5OZ EQUIV,31071027,CDM,250,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
MAALOX SUSP:30ML,31071029,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MAALOX:5OZ,31071030,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
CALCIUM CARB CHEW TAB 750MG,31071032,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TUMS TABLET:TUMS,31071033,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MYLANTA - PER 1 ML (bulk bottle),31071034,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
PHOSLO 667 MG CAPSULE,31071035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CALCIUM CARBONATE TAB:10GR,31071036,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SODIUM BICARBONATE 650 MG TABLET,31071037,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MOM/CASCARA-BAD#-OFF US MARKET-NONFORMLY,31071038,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
CALCIUM CARBONATE TAB 1250MG:1250MG,31071039,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CALCIUM CARBONATE 1250MG/5ML:5ML,31071040,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CALCIUM ACETATE 667MG:667MG,31071041,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
BICITRA 30ML DOSE,31071050,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
SOD BICARB TAB:1300MG,31071052,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SODIUM THIOSULFATE 12.5 GM 50ML SDV,31071100,CDM,250,RC,,,OUTPATIENT,,,142.00,56.80,,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.2,60,,68.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,99.4,70,,79.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,32,,36.35,percent of total billed charges,32% of total billed charges,45.44,120.7,
AMPHOGEL PLAIN LIQ 1OZ,31071501,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ALTERNAGEL:30ML,31071502,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
MAALOX TC:1OZ,31071503,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
RIOPAN 1OZ,31071507,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
GI COCKTAIL 4:1:1 RATIO - 30 ML,31071517,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MYLANTA II:1OZ UD EQUIV,31071527,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
LOMOTIL 2.5 MG TABLET,31072009,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
LACTINEX TAB:,31072015,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LOPERAMIDE 2 MG CAPSULE,31072016,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
IMODIUM AD LIQUID:10ML(BRAND NAME),31072017,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
LOPERAMIDE SOLN 2MG/10ML,31072018,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PROBIOTIC CAPSULE,31072503,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LACTINEX TAB:TAB,31072504,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DONNAGEL SUSP:15ML,31072505,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CULTURELLE PED PKT,31072506,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
KAOPECTATE SUSP:1OZ EQUIV,31072507,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PEPTO-BISMOL EQ 1ML,31072508,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
PEPTO BISMOL:15MG,31072510,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
LOMOTIL LIQUID:1OZ,31072513,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
CORRECTOL TABS,31073003,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOCUSATE 100 MG CAPSULE,31073004,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOCUSATE 200MG DOSE:200MG,31073005,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PERI-COLACE EQ-USE SENNA-S INSTEAD,31073009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SENNOSIDES 8.6 MG TABLET,31073010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CASCARA SAG FLUIDESTR OZ,31073011,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
CASTOR OIL PER OX,31073012,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
X-PREP:2.5 OZ,31073013,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
DOCUSATE/SENNA 50 MG/8.6 MG TABLET,31073014,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SENNOSIDES LIQ 8.8MG/5ML:5ML,31073015,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DOCUSATE 100MG/CASANTHROL 30MG CAP,31073017,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MINERAL OIL 30ML,31073018,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SURFAK CAP:240MG,31073020,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BISACODYL 10 MG RECTAL SUPPOSITORY,31073021,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
BISACODYL 5 MG TABLET,31073022,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CITRUCEL DOSE,31073024,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PHOSPHO-SODA 45ML:45ML,31073026,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
GLYCERIN RECTAL SUPPOSITORY ADULT,31073029,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GLYCERIN RECTAL SUPPOSITORY CHILD,31073030,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MILK OF MAGNESIA - 30 ML UNIT DOSE CUP,31073032,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
MIRALAX 3350 119GM:119GM,31073033,CDM,250,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
DOCUSATE 100MG/10ML LIQ,31073034,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIOCTO SYRUP 120MG/30ML:30MLS,31073035,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METAMUCIL 5.8GM PKT:PKT,31073036,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FIBERCON TABS,31073037,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MIRALAX POWDER - 238 GM BOTTLE,31073038,CDM,250,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
PERDIEM GRANULES:100GM,31073039,CDM,250,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
MOM/MINERAL OIL 30ML:MOM/MO,31073040,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PEG 3350 17 GRAM PACKET,31073041,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
GASTROVIEW 120ML:120ML,31073042,CDM,255,RC,,,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
DOCUSATE 50MG/5ML LIQ (note dose 5ml),31073060,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
MECLIZINE 12.5 MG TABLET,31075001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MECLIZINE 25 MG TABLET,31075002,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DRAMININE EQ TAB:50 MG,31075005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TIGAN CAP:100MG,31075006,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TIGAN CAP:250MG EQUIV,31075007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DRAMAMINE EQ INJ: 50MG/ML,31075009,CDM,636,RC,J1240,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
TIGAN INJ:2 ML,31075010,CDM,636,RC,J3250,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
IPECAC SYRUP:30ML,31075014,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
TIGAN SUPP: 200MG,31075023,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
TIGAN SUPP PED: 100MG,31075024,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
AXID CAPSULE 150MG:NF USE PEPCID 20MG,31075027,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MI-ACID (ANTACID/ANTIGAS) 30ML,31075105,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PROVERA TABS:10MG EQUIV,31080001,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ESTRADIOL 1 MG TABLET,31080002,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
MEDROXYPROGESTERONE 2.5MG:2.5MG,31080003,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MEDROXYPROGESTERONE 150MG SDV:150MG,31080004,CDM,636,RC,,,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
PARLODEL TAB:2.5 MG,31080022,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CORTEF:20MG,31081008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DEXAMETHASONE TAB: 1.5MG,31081009,CDM,636,RC,J8540,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DEXAMETHASONE TAB 4MG,31081010,CDM,636,RC,J8540,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
FLUDROCORTISONE 0.1 MG TABLET,31081011,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CORTISONE ACETATE TAB: 25MG,31081012,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
HYDROCORTISONE TABLET: 20MG,31081013,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MEDROL TAB:4MG X 21 DOSPAK EQUIV,31081015,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
CELESTONE EQ 6MG DOSE:6MG,31081016,CDM,636,RC,J0702,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
KENALOG 40MG/ML IM,31081017,CDM,636,RC,J3301,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
DEXAMETHASONE 10MG/ML:1ML,31081019,CDM,636,RC,J1100,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
DEXAMETHASONE 4 MG/ML - SDV,31081020,CDM,636,RC,J1100,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
DECADRON ELIXIR:PER OZ,31081021,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
predniSONE 5 MG TABLET,31081022,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
predniSONE 20 MG TABLET,31081023,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PREDNISONE SOL 1MG/ML 15ML,31081025,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
predniSONE 10 MG TABLET,31081026,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DEXAMETHASONE 20 MG/5 ML - MDV,31081027,CDM,636,RC,J1100,HCPCS,OUTPATIENT,,,117.00,46.80,,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.2,60,,56.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,81.9,70,,65.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,99.45,
PREDNISONE TAB 1MG:1MG,31081028,CDM,636,RC,J7512,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DEPO-Medrol 40 MG/ML,31081031,CDM,636,RC,J1010,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
methylPREDNISolone 4 MG TABLET,31081033,CDM,636,RC,J7509,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
METHYLPREDNSLN TAB 8MG:8MG,31081034,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DEXAMETHASONE 1MG/1ML SOLN,31081036,CDM,636,RC,J8540,HCPCS,OUTPATIENT,,,36.25,14.50,,,,,,other ,not seperately reimbursable,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.75,60,,17.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,30.81,85,,24.65,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,25.38,70,,20.3,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,11.6,32,,9.28,percent of total billed charges,32% of total billed charges,11.6,30.81,
DECADRON TURBINAIRE: 12.6GM,31081038,CDM,250,RC,,,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,96.9,
SOLU-Medrol <40MG/NS 4ML,31081040,CDM,636,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SOLU-MEDROL 60MG/6ML NS,31081041,CDM,636,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SOLU-MEDROL 80MG/NS 8ML,31081042,CDM,636,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SOLU-Medrol 40 MG,31081043,CDM,636,RC,J2919,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
SOLU-Medrol 125 MG,31081044,CDM,636,RC,J2919,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
SOLU-Medrol 500 MG,31081045,CDM,636,RC,J2919,HCPCS,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
SOLU-Medrol IV 1 GM,31081046,CDM,636,RC,,,OUTPATIENT,,,238.00,95.20,,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.8,60,,114.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,166.6,70,,133.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,32,,60.93,percent of total billed charges,32% of total billed charges,76.16,202.3,
Solu-CORTEF 100 MG VIAL,31081047,CDM,636,RC,J1720,HCPCS,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
SOLU CORTEF 250MG:250MG EQUIV,31081048,CDM,250,RC,,,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
SOLU-CORTEF 1000MG EQUIV,31081049,CDM,636,RC,J1720,HCPCS,OUTPATIENT,,,220.00,88.00,,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,187,
A-METHAPRED SDV 125MG:125MG,31081050,CDM,250,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
VANCERIL MDI:(42),31081052,CDM,250,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
VANCERIL DS MDI:(84),31081053,CDM,250,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
DEPO-Medrol 80 MG/ML,31081054,CDM,636,RC,J1010,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
DEPO-MEDROL  80 MG/ML 5ML MDV:5ML,31081055,CDM,636,RC,,,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,127.5,
SOLU-CORTEF:500MG  EQUIV,31081056,CDM,636,RC,J1720,HCPCS,OUTPATIENT,,,128.00,51.20,,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,60,,61.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,89.6,70,,71.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,108.8,
PREDNISOLONE ORAL SOLN 15MG/5ML,31081060,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
PREDNISLONE15MG/5ML 20ML UD,31081061,CDM,250,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
DEXAMETHASONE 0.5MG/5ML ORAL ELIXIR,31081070,CDM,636,RC,J8540,HCPCS,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
DEXAMETHASONE 10MG/ML:1ML,31081072,CDM,636,RC,J1100,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
SOLU-MEDROL IN NS,31081080,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
DECADRON ELIXIR:5 ML,31081521,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PRELONE 15MG/5ML 120ML BOTTLE:5ML DOSE,31081522,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ORAPRED 15 MG/5 ML - CHARGED PER ML,31081523,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
TESTOSTERONE 50 MG /2ML:10 ML,31082017,CDM,636,RC,J3140,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
CLIMARA 0.1MG PATCH,31084010,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
PREMARIN 0.625MG TAB : 0.625MG,31084011,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PREMARIN 0.3MG TAB : 0.3MG,31084012,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PREMARIN TAB : 1.25MG,31084013,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PREMPRO TAB: 0.625MG/2.5MG,31084014,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
PREMARIN TAB:0.9MG,31084015,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
AVODART CAP 0.5MG:0.5MG,31084016,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CLIMARA 0.05MG:PATCH,31084019,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
ESTRADURIN INJ:40 MG/2 ML,31084020,CDM,250,RC,,,OUTPATIENT,,,393.00,157.20,,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.8,60,,188.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,334.05,85,,267.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,275.1,70,,220.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,334.05,
ESTRADERM PATCH,31084021,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
TAMOXIFEN CITRATE 10MG:10MG,31084022,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MEGESTROL ACETATE:40MG,31084023,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MEGESTROL 40MG/ML 10ML,31084024,CDM,636,RC,S0179,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MEGESTROL 40MG/ML:20ML,31084025,CDM,636,RC,S0179,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
PREMARIN INJ  25 MG/5ML,31084026,CDM,636,RC,J1410,HCPCS,OUTPATIENT,,,440.00,176.00,,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,93.81,272,,,fee schedule,272% of BCBS fee schedule,93.81,272,,,fee schedule,272% of BCBS fee schedule,93.81,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,264,60,,211.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,308,70,,246.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,140.8,32,,112.64,percent of total billed charges,32% of total billed charges,93.81,374,
PREVEN CONTRACEPTIVE KIT:,31084027,CDM,250,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
LUPRON DEPOT 11.25MG:11.25MG 0,31084028,CDM,636,RC,J1950,HCPCS,OUTPATIENT,,,3735.00,1494.00,,1582.13,100,,,fee schedule,100% of Aetna fee schedule,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2241,60,,1792.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,3174.75,85,,2539.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,2614.5,70,,2091.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,1195.2,32,,956.16,percent of total billed charges,32% of total billed charges,1195.2,3174.75,
LUPRON DEPOT 3.75MG:3.75MG,31084029,CDM,636,RC,J1950,HCPCS,OUTPATIENT,,,1260.00,504.00,,1582.13,100,,,fee schedule,100% of Aetna fee schedule,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,756,60,,604.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,1071,85,,856.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,882,70,,705.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,403.2,32,,322.56,percent of total billed charges,32% of total billed charges,403.2,1582.13,
PLAN B - EMERGENCY CONTRACEPTION,31084042,CDM,250,RC,,,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
GLIMEPIRIDE TAB 1MG:1MG,31086002,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIABINESE TAB:250 MG,31086003,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DIABINESE TAB:100 MG,31086004,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DYMELOR TAB:250 MG,31086005,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TOLINASE TAB:100 MG,31086007,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TOLINASE TAB:250 MG,31086008,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ORINASE TAB:500MG EQUIV,31086009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ORINASE:250MG,31086010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
metFORMIN 500 MG TABLET,31086011,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
METFORMIN TB 850MG:850MG,31086012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
REZULIN:200MG,31086013,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
REZULIN:400MG-NON-FORMULARY,31086014,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
GLIMEPIRIDE 4 MG TABLET,31086015,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AVANDIA 4MG:4MG,31086016,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
AVANDIA 8MG:8MG,31086017,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
PIOGLITAZONE 15 MG TABLET,31086018,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACTOS 30MG:30MG,31086019,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ACTOS 45 MG TABLET,31086020,CDM,250,RC,,,OUTPATIENT,,,17.78,7.11,,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.67,60,,8.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,15.11,85,,12.09,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,12.45,70,,9.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,15.11,
PRANDIN 1MG TAB:1MG,31086021,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
AVANDIA 2MG:2MG,31086022,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
GLIMEPIRIDE 2 MG TABLET,31086023,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
JANUVIA 50 MG TABLET,31086024,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
JANUVIA 100 MG TABLET,31086025,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
JANUVIA 25 MG TABLET,31086026,CDM,250,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
INSULIN - LEVEMIR - PER UNIT,31086029,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
metFORMIN 1000 MG TABLET,31086030,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GLUCAGON INJ 1MG/ML,31086031,CDM,636,RC,J1610,HCPCS,OUTPATIENT,,,320.00,128.00,,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,60,,153.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,272,85,,217.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,224,70,,179.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,102.4,32,,81.92,percent of total billed charges,32% of total billed charges,102.4,272,
HUMAN-INSULIN 50/50:ANY DOSE,31086032,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
INSULIN - HUMALOG MIX 75/25 - PER UNIT,31086033,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
INSULIN - HUMULIN 70/30 - PER UNIT,31086034,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
CHANGE TO NOVOLOG-ASPART 31086039,31086035,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
INSULIN-HUMAN LENTE:ANY DOSE,31086036,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
INSULIN (HUMULIN)70/30 DOSE,31086037,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
INSULIN LANTUS-USE LEVEMIR,31086038,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
INSULIN - NOVOLOG - PER UNIT,31086039,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
INSULIN APIDRA  DOSE,31086040,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
INSULIN - NPH - PER UNIT,31086041,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
INSULIN - REGULAR - PER UNIT,31086042,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
GLYBURIDE TAB 1.25MG: 1.25MG,31086043,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GLYBURIDE TAB 2.5MG,31086044,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
#NAME?,31086045,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
glyBURIDE 5 MG TABLET,31086046,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GLYBURIDE MICRO 3MG TAB: 3MG,31086047,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
GLYBURIDE MICRONIZED TAB:6MG,31086048,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
INSULIN - HUMALOG - PER UNIT,31086049,CDM,250,RC,J1815,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
SSRI-MOHAMMED,31086050,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
TRADJENTA 5MG TAB,31086060,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
ZOLEDRONIC ACID 5 MG/100 ML IVPB,31087005,CDM,636,RC,J3489,HCPCS,OUTPATIENT,,,352.77,141.11,,,,,,other ,not seperately reimbursable,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.66,60,,169.33,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,299.85,85,,239.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,246.94,70,,197.55,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,112.89,32,,90.31,percent of total billed charges,32% of total billed charges,112.89,299.85,
BONIVA IV 3MG/3ML:3ML,31087006,CDM,636,RC,J1740,HCPCS,OUTPATIENT,,,776.00,310.40,,41.54,100,,,fee schedule,100% of Aetna fee schedule,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.6,60,,372.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,543.2,70,,434.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,248.32,32,,198.66,percent of total billed charges,32% of total billed charges,41.54,659.6,
FOSAMAX:NON-FORMULARY,31087007,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
OS-CAL TABLET EQUIV,31087008,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SANDOSTATIN 100MCG/ML:100MCG,31087009,CDM,636,RC,J2354,HCPCS,OUTPATIENT,,,98.00,39.20,,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.8,60,,47.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,68.6,70,,54.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,83.3,
PAMIDRONATE 90MG:90MG,31087010,CDM,636,RC,J2430,HCPCS,OUTPATIENT,,,65.40,26.16,,10.7,100,,,fee schedule,100% of Aetna fee schedule,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.24,60,,31.39,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,55.59,85,,44.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,45.78,70,,36.62,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,20.93,32,,16.74,percent of total billed charges,32% of total billed charges,10.7,55.59,
PAMIDRONATE 60MG:60MG,31087011,CDM,636,RC,J2430,HCPCS,OUTPATIENT,,,1646.00,658.40,,10.7,100,,,fee schedule,100% of Aetna fee schedule,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,987.6,60,,790.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,1152.2,70,,921.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,526.72,32,,421.38,percent of total billed charges,32% of total billed charges,10.7,1399.1,
PROLIA 60MG/1ML,31087012,CDM,636,RC,J0897,HCPCS,OUTPATIENT,,,1100.00,440.00,,20.11,100,,,fee schedule,100% of Aetna fee schedule,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,660,60,,528,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,770,70,,616,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,352,32,,281.6,percent of total billed charges,32% of total billed charges,352,32,,281.6,percent of total billed charges,32% of total billed charges,20.11,935,
METHIMAZOLE 5MG TAB:5MG,31087014,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
methIMAzole 10 MG TABLET,31087015,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SYNTHROID 0.05 MG TAB,31087016,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SYNTHROID 0.1 MG TAB,31087017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SYNTHROID 0.075 MG TAB,31087018,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ARMOUR THYROID 30MG:30MG,31087019,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
THYROID TAB:60 MG/1 GR,31087023,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LIOTHYRONINE TAB 0.025MG,31087027,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CALCIUM GLUCONATE 10% - 4.65 MEQ/10 ML,31087032,CDM,636,RC,J0612,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
CALCIUM CHLORIDE 10% (1 GM/10 ML) SDV,31087035,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
CALCIUM CHLORIDE 10% PREFILLED SYRINGE,31087036,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
LEVOTHYROXINE 0.025 MG TAB,31087037,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SYNTHROID INJ: 500MCG,31087038,CDM,250,RC,,,OUTPATIENT,,,303.00,121.20,,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.8,60,,145.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,212.1,70,,169.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,32,,77.57,percent of total billed charges,32% of total billed charges,96.96,257.55,
LEVOTHYROXINE 100 MCG SDV,31087039,CDM,250,RC,,,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,157.25,
SYNTHROID 0.088 MG TAB,31087040,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SYNTHROID 0.112 MG TAB,31087041,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SYNTHROID 0.125 MG TAB,31087042,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SYNTHROID TAB: 0.15MG,31087043,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PROPYLTHIOURACIL 50MG TAB,31087044,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SYNTHROID TAB 0.137MG:0.137MG,31087045,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VASOPRESSIN 20 UNITS/ML SDV,31088004,CDM,250,RC,,,OUTPATIENT,,,139.70,55.88,,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.82,60,,67.06,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,118.75,85,,95,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,97.79,70,,78.23,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,32,,35.76,percent of total billed charges,32% of total billed charges,44.7,118.75,
OXYTOCIN  INJ 10 UNITS/ML,31088006,CDM,636,RC,J2590,HCPCS,OUTPATIENT,,,34.00,13.60,,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,60,,16.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,23.8,70,,19.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,32,,8.7,percent of total billed charges,32% of total billed charges,10.88,28.9,
BAD #,31088888,CDM,112,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
PANGLOBULIN IV 6GM:6GM,31090005,CDM,636,RC,,,OUTPATIENT,,,883.00,353.20,,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,529.8,60,,423.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,750.55,85,,600.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,618.1,70,,494.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,32,,226.05,percent of total billed charges,32% of total billed charges,282.56,750.55,
ABSOLUTE ALCOHOL IV : 2ML,31090017,CDM,250,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
DIPRIVAN AMP: 200MG,31090018,CDM,250,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
PROPOFOL 200 MG/20 ML,31090019,CDM,636,RC,J2704,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
PROPOFOL 500 MG/50 ML,31090020,CDM,258,RC,J2704,HCPCS,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
PROPOFOL 1000 MG/100 ML,31090021,CDM,636,RC,J2704,HCPCS,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,105.4,
LIDOCAINE 2% VISCOUS  - PER 1 ML,31090027,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
CLINIMIX 4.25/5 1L,31090028,CDM,258,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
VANCOMYCIN 1.5 GM/300 ML - PREMIXED BAG,31090029,CDM,258,RC,J3370,HCPCS,OUTPATIENT,,,24.26,9.70,,2.61,100,,,fee schedule,100% of Aetna fee schedule,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.56,60,,11.65,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,20.62,85,,16.5,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,16.98,70,,13.58,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,7.76,32,,6.21,percent of total billed charges,32% of total billed charges,2.61,20.62,
CETACAINE SPRAY:50 ML,31090030,CDM,250,RC,,,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
BENZOCAINE/MENTHOL 20%-0.5% SPRAY - 56GM,31090031,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
VANCOMYCIN 2 GM/400 ML - PREMIXED BAG,31090032,CDM,258,RC,J3370,HCPCS,OUTPATIENT,,,32.40,12.96,,2.61,100,,,fee schedule,100% of Aetna fee schedule,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.44,60,,15.55,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,27.54,85,,22.03,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,22.68,70,,18.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,10.37,32,,8.3,percent of total billed charges,32% of total billed charges,2.61,27.54,
KETAMINE 500MG/10ML SDV,31090036,CDM,250,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
XYLOCAINE JELLY UROJECT:10 ML,31090038,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
AMIDATE 40 MG/20 ML SDV,31090040,CDM,250,RC,,,OUTPATIENT,,,187.00,74.80,,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.2,60,,89.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,130.9,70,,104.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,158.95,
HURRICAINE 20% SPRAY - 57 GM BOTTLE,31090048,CDM,250,RC,,,OUTPATIENT,,,58.00,23.20,,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
SUCCINYLCHOLINE 20MG/ML 1ML DOSE,31090059,CDM,636,RC,J0330,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
ANCETINE FLO-PAK:500 MG,31090067,CDM,250,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
MAGIC MOUTHWASH NON-THRUSH - 1:1:1 RATIO,31090068,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ADM RABIES VACCINE EA ADD'L,31090472,CDM,259,RC,90472,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.64,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
XYLOCAINE 2% VISCOUS - 15 ML UNIT DOSE,31090527,CDM,250,RC,,,OUTPATIENT,,,6.04,2.42,,,,,,other ,not seperately reimbursable,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.62,60,,2.9,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,5.13,85,,4.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,4.23,70,,3.38,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,1.93,32,,1.54,percent of total billed charges,32% of total billed charges,1.93,5.13,
KETAMINE 500 MG/10 ML MDV,31090536,CDM,250,RC,,,OUTPATIENT,,,128.00,51.20,,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,60,,61.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,89.6,70,,71.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,32,,32.77,percent of total billed charges,32% of total billed charges,40.96,108.8,
DIAPER RASH OINTMENT 4OZ,31091001,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
A & D OINTMENT - 42.5 GM TUBE,31091002,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
BACITRACIN ZN OINT:15GM,31091003,CDM,250,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
LAC-HYDRIN 12% LOTION 225GM:225GM,31091004,CDM,250,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
BETADINE OINT PKT 0.9GM,31091005,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
POVIDONE-IODINE CREAM:15GM,31091006,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
BETADINE OINT 30GM TUBE,31091007,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
AVEENO LOTION,31091008,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
AVEENO BATH OIL,31091009,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
CORTICAINE CREAM,31091011,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CORTISPORIN CREAM:7.5GM,31091012,CDM,250,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
NEOMYCIN/POLYMXN/HC CREAM,31091014,CDM,250,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
CORTISPORIN TOP OINT:1/2 OZ,31091015,CDM,250,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
MOMETASONE FUR CRM 0.1%:45GM,31091019,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
MOMETASONE FUR OINT 0.1%:45GM,31091020,CDM,250,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
TRIAMCIN ACET 0.025% CR 80GM:80GM,31091021,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
TRIAMCINOLONE 0.1% DNTL 5GM:5GM,31091022,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
DESOXIMETASONE CRM 0.25% 60GM:60GM,31091023,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
TRIAMCIN ACET 0.1% 454GM:454GM,31091024,CDM,250,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
GENTAMICIN OINT 0.1%: 15GM,31091025,CDM,250,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
ELOCON 0.1% CREAM 15GM:15GM,31091026,CDM,250,RC,,,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
TRIAMCINOLONE CRM 0.5% 15GM:15GM,31091027,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
HYDROCORTISONE 1% CREAM - 30 GM TUBE,31091028,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
HYDROCORTISONE 1% OINT,31091029,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
HYDROCORTISONE CR 0.5%:1 OZ,31091030,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
TOPICORD CR 0.25%:15 GM,31091031,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
HYDROCORTISONE VAL 0.2%:45GM,31091032,CDM,250,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
KENALOG OINT 0.1% 15 GM EQUIV,31091033,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
TRIAMCINOLONE CRM 0.1% 15GM:15GM,31091034,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
CLOTRIMAZOLE CR:45GM,31091035,CDM,250,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
CLOTRIMAZOLE/BETAMETHASONE CREAM - 15 GM,31091036,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
CLOTRIMAZOLE CREAM 1% 15GM:15GM,31091037,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
ETHYL CHLORIDE TREATMENT,31091038,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CLOTRIMAZOLE/BETAMETH CR:45GM,31091039,CDM,250,RC,,,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,127.5,
LOTRISONE LOTION 30ML:30ML,31091040,CDM,250,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
CICLOPIROX CR 0.77% 15GM:15GM,31091041,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
NYSTAT/TRIAMCINLN CR 60GM:60GM,31091042,CDM,250,RC,,,OUTPATIENT,,,274.46,109.78,,,,,,other ,not seperately reimbursable,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.68,60,,131.74,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,233.29,85,,186.63,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,192.12,70,,153.7,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,87.83,32,,70.26,percent of total billed charges,32% of total billed charges,87.83,233.29,
NYSTATIN/TRIAMCINOLONE CREAM -15 GM TUBE,31091044,CDM,250,RC,,,OUTPATIENT,,,145.00,58.00,,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87,60,,69.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,101.5,70,,81.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,32,,37.12,percent of total billed charges,32% of total billed charges,46.4,123.25,
NYSTATIN/TRIAMCINOLONE OINTMENT 15 GM,31091045,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
LAMISIL 1% CR 12GM:12GM,31091046,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
CLOTRIMAZOLE 1% CREAM - 15 GM TUBE,31091050,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
ZINC OXIDE 40% PASTE - 57 GM TUBE,31091052,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
FLUOCINONIDE CR 0.05% 15GM:15GM,31091054,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
FLUOCINONIDE CR 0.025% 15GM:15GM,31091056,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
BACTROBAN NSL OINT 1GM,31091061,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
TRIPLE PASTE 2OZ:2OZ,31091062,CDM,250,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
CLOBETASOL CRM 0.05% 30GM,31091063,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
FORMULATION R OINT 1OZ,31091064,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CAPSAICIN 0.1% CR:45GM,31091065,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
BEN-GAY ORIG 60GM:60GM,31091066,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
ASPERCREME 10% 90GM:90GM,31091067,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
BETAMETHASONE DIP CRM 0.05% 45GM:45GM,31091069,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
POLYSPORIN OINTMENT 15GM,31091070,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
MUPIROCIN 2% CREAM - 15 GM TUBE,31091071,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.6,40,,33.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
TOLNAFTATE POWDR 45GM:45GM,31091072,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
LIDOCAINE 2% OPTH DOSE,31091073,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
TRIPLE ANTIBIOTIC OINTMENT - 30 GM TUBE,31091074,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
MUPIROCIN 2% OINTMENT - 22 GM TUBE,31091075,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
BACTROBAN EQ OINT 1 APPLICATION (pkt),31091076,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TINACTIN CREAM 1% 15 GM,31091077,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
TINACTIN SPRAY,31091078,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
BETAMETHASONE VAL 0.1% OI:15GM,31091079,CDM,250,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
WYDASE:1 ML,31091080,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
LIDOCAINE 4% INJ 30ML,31091081,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
LIDOCAINE 1% 20 ML MDV,31091082,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
LIDOCAINE 2% 20ML MDV,31091083,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
ORAJEL BABY 7.5% 9.4GM:9.4GM,31091084,CDM,250,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
ZINC OXIDE 20% OINTMENT - 30 GM TUBE,31091085,CDM,250,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
XYLO PF 4% (200MG) 5ML,31091086,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
GOLD BOND:4OZ,31091087,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
NUPERCAINAL EQ OINT 1% 1OZ,31091088,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
BUPIVICAINE 0.25% W/EPI 10ML MDV,31091089,CDM,250,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
EMLA CREAM - 5 GM TUBE,31091090,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
XYLOCAINE OINT 5%:1 OZ,31091091,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
XYLOCAINE JELLY 2% 30ML,31091092,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
XYLOCAINE 2%PLAIN:10ML,31091093,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
BUPIVICAINE MPF 0.5% 30ML,31091094,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
LTA:360 KIT,31091095,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
BUPIVICAINE MPF 0.25% W/EPI 30ML,31091096,CDM,250,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
LIDOCAINE 2% JELLY 30ML,31091097,CDM,250,RC,,,OUTPATIENT,,,148.25,59.30,,,,,,other ,not seperately reimbursable,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.95,60,,71.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,59.3,40,,47.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,126.01,85,,100.81,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,103.78,70,,83.02,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,47.44,32,,37.95,percent of total billed charges,32% of total billed charges,47.44,126.01,
MARCAINE 0.25% 10ML,31091098,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
MARCAINE 0.75%:10ML,31091099,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
MARCAINE 0.75% W/EPI 10ML,31091100,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
SENSORCAINE-MPF 0.5% W/ EPI 10ML,31091101,CDM,250,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
LIDOCAINE 5% TOPICAL PATCH,31091102,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
MARCAINE 0.5%/EPI 30ML,31091103,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
NAROPIN 0.2% 20ML SDV:20ML,31091104,CDM,636,RC,J2795,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
ROPIVACAINE 0.5% 30ML:30ML,31091105,CDM,636,RC,J2795,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
ROPIVICAINE 0.2% 100ML:100ML,31091106,CDM,636,RC,J2795,HCPCS,OUTPATIENT,,,124.00,49.60,,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,60,,59.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,86.8,70,,69.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,32,,31.74,percent of total billed charges,32% of total billed charges,39.68,105.4,
ROPIVICAINE 0.2% 200ML:200ML,31091107,CDM,636,RC,J2795,HCPCS,OUTPATIENT,,,195.00,78.00,,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117,60,,93.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,136.5,70,,109.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,32,,49.92,percent of total billed charges,32% of total billed charges,62.4,165.75,
MARCAINE SPINAL 0.75% 2ML,31091108,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
EMLA CREAM - 30 GM TUBE,31091109,CDM,250,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
DECASPRAY AEROSOL:25 GM,31091110,CDM,250,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
EMLA:BACTROBAN CR 1:1: 60GM,31091111,CDM,250,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
LIDOCAINE 1% 2ML SDV MPF,31091112,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
SENSORCAINE MPF 0.75%:30ML,31091113,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
LTA 360 LIDOCAINE 4% KIT,31091120,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
PROCTOFOAM-HC AEROSOL:10GM,31091124,CDM,250,RC,,,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
HYDROCORTISONE ENEMA 60ML:60ML,31091126,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
AVC VAG CREAM W/ APPL:4 OZ,31091128,CDM,250,RC,,,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
SULTRIN VAG CREAM:78GM,31091131,CDM,250,RC,,,OUTPATIENT,,,98.00,39.20,,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.8,60,,47.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,68.6,70,,54.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,83.3,
TERAZOL-3 SUPP,31091132,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
TERCONAZOLE VAG CRM 20GM:20GM,31091133,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
MICONAZOLE 2% 45GM VAG CRM:45GM,31091134,CDM,250,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
AVC VAG SUPP BOX :16 W/APPL,31091136,CDM,250,RC,,,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
AVC W/DIENEST VAG CR:4 OZ,31091137,CDM,250,RC,,,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
MICONAZOLE 2% VAGINAL CREAM - 30 GM TUBE,31091140,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
LOTRIMIN AF 2% PWDR 90GM,31091141,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
VAGISIL CREAM 1.25OZ,31091144,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
PREMARIN VAG CREAM COMBO PACK,31091145,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
FURACIN SOL DRESSING 1 LB,31091151,CDM,250,RC,,,OUTPATIENT,,,191.00,76.40,,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.6,60,,91.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,162.35,
KERI-LOTION,31091152,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
BALMEX TUBE: 2OZ,31091153,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
POVIDONE-IODINE 10% OINTMENT - 30GM TUBE,31091160,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
TRIAMCIN ACET 0.025% CR 15GM,31091162,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TRIAMCINOLONE 0.1% CREAM - 15 GM TUBE,31091163,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SILVER SULFADIAZENE 1% CREAM - 400 GM,31091173,CDM,250,RC,,,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,75.65,
AMERIGEL WOUND DRESSING 30GM:30GM,31091174,CDM,250,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
CHAPSTICK 4 GM TUBE,31091183,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PETROLEUM JELLY - 28.4 GM TUBE,31091184,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
CETAPHIL MOISTURIZING LOTION:240ML,31091185,CDM,250,RC,,,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
CALAMINE LOTION - 177 ML BOTTLE,31091186,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
LANTISEPTIC JAR 400GM,31091187,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
AMLACTIN 12% CRM:AMLACTIN 140GM,31091188,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
PETROLEUM JELLY 5GM:5GM,31091189,CDM,250,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
RID 0.5% SPRAY,31091190,CDM,250,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
NIX  LICE TXMENT SYSTEM,31091192,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
LINDANE LOTION 1% 60ML:60ML,31091193,CDM,250,RC,,,OUTPATIENT,,,205.00,82.00,,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123,60,,98.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,143.5,70,,114.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,32,,52.48,percent of total billed charges,32% of total billed charges,65.6,174.25,
CROTAMITON CREAM:60GM,31091194,CDM,250,RC,,,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
PERMETHRIN 5% CR 60GM:60GM,31091195,CDM,250,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
PERMETHRIN 5% CREAM - 60 GM,31091196,CDM,250,RC,,,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,119,
SELSUN SHAMPOO SUSP:4OZ,31091205,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
TUCKS PAD: 40S PKG 1,31091207,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
NUPERCAINAL SUPP: EQ,31091223,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ANUSOL SUPP PLAIN,31091224,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ANUSOL 25 MG RECTAL SUPPOSITORY,31091225,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
GRANULEX AEROSOL:2 OZ,31091229,CDM,250,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
DESOXIMETASONE CR 0.25% 15GM:0.25%,31091230,CDM,250,RC,,,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
SILVER SULFADIAZENE 1% CREAM - 50 GM,31091244,CDM,250,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
SILVER SULFADIAZINE 1% CREAM - 25 GM,31091245,CDM,250,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
SULFAMYLON CREAM:60GM,31091246,CDM,250,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
MONISTAT-DERM CREAM 2%:15GM,31091248,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
TUCKS OINTMENT 28GM:28GM,31091254,CDM,250,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
HYDROCORTISONE 2.5% CREAM - 30 GM TUBE,31091255,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
PROCTOZONE HC CREAM - 30 GM TUBE,31091256,CDM,250,RC,,,OUTPATIENT,,,27.90,11.16,,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.74,60,,13.39,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,23.72,85,,18.98,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,19.53,70,,15.62,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,23.72,
GYNE-LOTRIMIN VAG CREAM,31091257,CDM,250,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
GYNE-LOTRIMIN VAG TABS,31091258,CDM,250,RC,,,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
LIDEX CREAM:15 GM,31091259,CDM,250,RC,,,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
MYOFLEX CREME:2OZ,31091260,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
FLUOCINONIDE CR 0.05% 30GM:30GM,31091261,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
DESOXIMETASONE CR 0.05% 60GM:0.05%,31091262,CDM,250,RC,,,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
METROGEL 0.75%:30GM,31091263,CDM,250,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
DESOXIMETASONE OINT 0.25% 15GM:0.25%,31091264,CDM,250,RC,,,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
METRONID VAG GEL 0.75%:70GM,31091265,CDM,250,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
PROCTOFOAM AEROSOL,31091269,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
GENTIAN VIOLET 1%:1 BTL,31091271,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
TRIPLE ANTIBIOTIC OINTMENT - 0.9 GM PACK,31091272,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SILVER NITRATE STICK,31091273,CDM,250,RC,,,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
PHISODERM:5OZ,31091274,CDM,250,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
PROTOPAM CHLORIDE,31091277,CDM,250,RC,,,OUTPATIENT,,,417.00,166.80,,,,,,other ,not seperately reimbursable,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.2,60,,200.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,291.9,70,,233.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,133.44,32,,106.75,percent of total billed charges,32% of total billed charges,133.44,354.45,
MARCAINE 0.5%-10ML,31091289,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
LIDOCAINE MPF 0.5%:50 ML,31091296,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
XYLOCAINE MPF 1%:30 ML,31091297,CDM,250,RC,,,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
LIDOCAINE 2% MPF 5ML SDV,31091305,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
XYLOCAINE-MPF 1% 5ML,31091306,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
XYLOCAINE 2%W/EPI 30ML,31091313,CDM,250,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
NOVOCAIN 10% SPINAL 2ML:2ML,31091314,CDM,250,RC,,,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
d10w,31091315,CDM,250,RC,,,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,115.6,
XYLOCAINE 1% W/EPI 30 ML,31091321,CDM,250,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
SENSORCAINE-MPF 0.25% 30ML,31091330,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
ACETYLCYSTEINE 10% INHALANT - 4 ML VIAL,31091331,CDM,250,RC,,,OUTPATIENT,,,11.04,4.42,,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.62,60,,5.3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,9.38,85,,7.5,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,7.73,70,,6.18,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,32,,2.82,percent of total billed charges,32% of total billed charges,3.53,9.38,
AMMONIA INHALANT AMPULES,31091332,CDM,250,RC,,,OUTPATIENT,,,6.56,2.62,,,,,,other ,not seperately reimbursable,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.94,60,,3.15,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,5.58,85,,4.46,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,4.59,70,,3.67,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,2.1,32,,1.68,percent of total billed charges,32% of total billed charges,2.1,5.58,
AMPICILLIN 2 GM VIAL,31091333,CDM,250,RC,J0290,HCPCS,OUTPATIENT,,,7.98,3.19,,,,,,other ,not seperately reimbursable,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,5.06,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,4.79,60,,3.83,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,6.78,85,,5.42,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,5.59,70,,4.47,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,2.55,32,,2.04,percent of total billed charges,32% of total billed charges,2.55,6.78,
ASPIRIN 300 MG SUPPOSITORY,31091334,CDM,250,RC,,,OUTPATIENT,,,6.88,2.75,,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.13,60,,3.3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,5.85,85,,4.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,4.82,70,,3.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,5.85,
ATROPINE 0.4 MG/ML - 20 ML MDV,31091335,CDM,636,RC,J0461,HCPCS,OUTPATIENT,,,42.95,17.18,,,,,,other ,not seperately reimbursable,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.77,60,,20.62,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,36.51,85,,29.21,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,30.07,70,,24.06,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,13.74,32,,10.99,percent of total billed charges,32% of total billed charges,13.74,36.51,
AZITHROMYCIN 200 MG/5 ML SUSP -25 ML BTL,31091336,CDM,636,RC,J0456,HCPCS,OUTPATIENT,,,17.25,6.90,,,,,,other ,not seperately reimbursable,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.35,60,,8.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,14.66,85,,11.73,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,12.08,70,,9.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,5.52,32,,4.42,percent of total billed charges,32% of total billed charges,5.52,14.66,
AZITHROMYCIN 200 MG/5 ML SUSP -30 ML BTL,31091337,CDM,636,RC,J0456,HCPCS,OUTPATIENT,,,19.15,7.66,,,,,,other ,not seperately reimbursable,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.49,60,,9.19,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,16.28,85,,13.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,13.41,70,,10.73,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,6.13,32,,4.9,percent of total billed charges,32% of total billed charges,6.13,16.28,
BENZOCAINE (AMERICAINE) OINT 20% - 28 GM,31091338,CDM,250,RC,,,OUTPATIENT,,,11.13,4.45,,,,,,other ,not seperately reimbursable,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.68,60,,5.34,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,9.46,85,,7.57,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,7.79,70,,6.23,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,3.56,32,,2.85,percent of total billed charges,32% of total billed charges,3.56,9.46,
BENZOCAINE (HURRICAINE) SPRAY 57 GM BTL,31091339,CDM,250,RC,,,OUTPATIENT,,,41.30,16.52,,,,,,other ,not seperately reimbursable,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.78,60,,19.82,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,35.11,85,,28.09,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,28.91,70,,23.13,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,13.22,32,,10.58,percent of total billed charges,32% of total billed charges,13.22,35.11,
BERACTANT 25 MG/ML - 4 ML SDV,31091340,CDM,250,RC,,,OUTPATIENT,,,339.29,135.72,,,,,,other ,not seperately reimbursable,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.57,60,,162.86,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,288.4,85,,230.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,237.5,70,,190,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,108.57,32,,86.86,percent of total billed charges,32% of total billed charges,108.57,288.4,
BIOTRUE SOFT LENS RINSE SOLN 296 ML BOTT,31091341,CDM,250,RC,,,OUTPATIENT,,,15.99,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.59,60,,7.67,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.59,85,,10.87,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.19,70,,8.95,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.59,
BUPIVACAINE IN DEX 0.75%-8.25% - 2 ML,31091342,CDM,636,RC,S0020,HCPCS,OUTPATIENT,,,7.65,3.06,,,,,,other ,not seperately reimbursable,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.59,60,,3.67,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,6.5,85,,5.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,5.36,70,,4.29,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,2.45,32,,1.96,percent of total billed charges,32% of total billed charges,2.45,6.5,
DIPTHERIA/TETANUS/PERTUSSIS  VACCINE 0.5,31091343,CDM,636,RC,90700,HCPCS,OUTPATIENT,,,41.21,16.48,,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.73,60,,19.78,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,35.03,85,,28.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,28.85,70,,23.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,35.03,
DEXTROSE TABLETS,31091344,CDM,250,RC,,,OUTPATIENT,,,41.21,16.48,,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.73,60,,19.78,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,35.03,85,,28.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,28.85,70,,23.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,32,,10.55,percent of total billed charges,32% of total billed charges,13.19,35.03,
DEXTROSE 10% IN WATER - 1000 ML BAG - 2B,31091345,CDM,250,RC,,,OUTPATIENT,,,7.38,2.95,,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.43,60,,3.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,6.27,85,,5.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,5.17,70,,4.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,6.27,
dilTIAZem 125 MG/25 ML SDV,31091346,CDM,250,RC,,,OUTPATIENT,,,10.99,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.59,60,,5.27,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.34,85,,7.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.69,70,,6.15,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.34,
FLUORESCEIN SODIUM (AK-FLUOR) 10% INJ -,31091347,CDM,250,RC,,,OUTPATIENT,,,32.43,12.97,,,,,,other ,not seperately reimbursable,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.46,60,,15.57,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,27.57,85,,22.06,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,22.7,70,,18.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,10.38,32,,8.3,percent of total billed charges,32% of total billed charges,10.38,27.57,
BIO GLO 1 MG OPHTHALMIC STRIP,31091348,CDM,250,RC,,,OUTPATIENT,,,5.19,2.08,,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.11,60,,2.49,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,4.41,85,,3.53,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,3.63,70,,2.9,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,4.41,
DAKIN'S 0.125% - QUARTER STRENGTH,31091349,CDM,250,RC,,,OUTPATIENT,,,18.15,7.26,,,,,,other ,not seperately reimbursable,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.89,60,,8.71,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,15.43,85,,12.34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,12.71,70,,10.17,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,5.81,32,,4.65,percent of total billed charges,32% of total billed charges,5.81,15.43,
HYDROmorphone 50 MG/5 ML AMPULE,31091350,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,13.48,5.39,,,,,,other ,not seperately reimbursable,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.09,60,,6.47,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,11.46,85,,9.17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,9.44,70,,7.55,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,4.31,32,,3.45,percent of total billed charges,32% of total billed charges,4.31,11.46,
IBUPROFEN 100 MG/5 ML - 120 ML BOTTLE,31091351,CDM,250,RC,,,OUTPATIENT,,,8.76,3.50,,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.26,60,,4.21,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,7.45,85,,5.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,6.13,70,,4.9,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,7.45,
IODIXANOL 270 MG/ML - 100 ML,31091352,CDM,636,RC,Q9966,HCPCS,OUTPATIENT,,,49.03,19.61,,,,,,other ,not seperately reimbursable,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.42,60,,23.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,41.68,85,,33.34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,34.32,70,,27.46,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,15.69,32,,12.55,percent of total billed charges,32% of total billed charges,15.69,41.68,
LOPERAMIDE 1 MG/7.5 ML SUSPENSION - 120,31091353,CDM,250,RC,,,OUTPATIENT,,,8.76,3.50,,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.26,60,,4.21,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,7.45,85,,5.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,6.13,70,,4.9,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,7.45,
LIDOCAINE HCL 2% JELLY - 5 ML TUBE,31091354,CDM,250,RC,,,OUTPATIENT,,,13.75,5.50,,,,,,other ,not seperately reimbursable,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.25,60,,6.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,11.69,85,,9.35,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,9.63,70,,7.7,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,4.4,32,,3.52,percent of total billed charges,32% of total billed charges,4.4,11.69,
LIDOCAINE W/EPI 2% - 0.0005% - 20 ML SDV,31091355,CDM,250,RC,,,OUTPATIENT,,,21.50,8.60,,,,,,other ,not seperately reimbursable,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.9,60,,10.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,18.28,85,,14.62,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,15.05,70,,12.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,6.88,32,,5.5,percent of total billed charges,32% of total billed charges,6.88,18.28,
LIDOCAINE W/EPI 1% - 0.001% - 20 ML MDV,31091356,CDM,250,RC,,,OUTPATIENT,,,6.49,2.60,,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.89,60,,3.11,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,5.52,85,,4.42,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,4.54,70,,3.63,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,32,,1.66,percent of total billed charges,32% of total billed charges,2.08,5.52,
LOSARTAN 25 MG TABLET,31091357,CDM,250,RC,,,OUTPATIENT,,,5.41,2.16,,,,,,other ,not seperately reimbursable,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.25,60,,2.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,4.6,85,,3.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,3.79,70,,3.03,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,1.73,32,,1.38,percent of total billed charges,32% of total billed charges,1.73,4.6,
LUBRICATING JELLY - 56.5 GRAM TUBE,31091358,CDM,250,RC,,,OUTPATIENT,,,6.36,2.54,,,,,,other ,not seperately reimbursable,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.82,60,,3.06,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,5.41,85,,4.33,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,4.45,70,,3.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,2.04,32,,1.63,percent of total billed charges,32% of total billed charges,2.04,5.41,
SODIUM CHLORIDE 0.65% - 30 ML BTL,31091359,CDM,250,RC,,,OUTPATIENT,,,8.76,3.50,,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.26,60,,4.21,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,7.45,85,,5.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,6.13,70,,4.9,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,32,,2.24,percent of total billed charges,32% of total billed charges,2.8,7.45,
DAKIN'S 0.25% - HALF STRENGTH,31091360,CDM,250,RC,,,OUTPATIENT,,,18.25,7.30,,,,,,other ,not seperately reimbursable,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.95,60,,8.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,15.51,85,,12.41,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,12.78,70,,10.22,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,5.84,32,,4.67,percent of total billed charges,32% of total billed charges,5.84,15.51,
STERILE WATER FOR INJ - 2000 ML BAG - 2B,31091361,CDM,636,RC,A4217,HCPCS,OUTPATIENT,,,11.35,4.54,,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.81,60,,5.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,9.65,85,,7.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,7.95,70,,6.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,9.65,
STERILE WATER FOR INJ (DILUENT/VACCINES),31091362,CDM,636,RC,A4217,HCPCS,OUTPATIENT,,,11.35,4.54,,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.81,60,,5.45,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,9.65,85,,7.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,7.95,70,,6.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,32,,2.9,percent of total billed charges,32% of total billed charges,3.63,9.65,
STERILE WATER FOR IRRIGAT - 3000 ML BAG,31091363,CDM,636,RC,A4217,HCPCS,OUTPATIENT,,,12.35,4.94,,,,,,other ,not seperately reimbursable,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.41,60,,5.93,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,10.5,85,,8.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,8.65,70,,6.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,3.95,32,,3.16,percent of total billed charges,32% of total billed charges,3.95,10.5,
TERBUTALINE SULFATE 1 MG/ML - 1 ML SDV,31091364,CDM,636,RC,J3105,HCPCS,OUTPATIENT,,,6.60,2.64,,,,,,other ,not seperately reimbursable,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.96,60,,3.17,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,5.61,85,,4.49,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,4.62,70,,3.7,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,2.11,32,,1.69,percent of total billed charges,32% of total billed charges,2.11,5.61,
TERMINITOR LICE COMB,31091365,CDM,272,RC,,,OUTPATIENT,,,9.91,3.96,,,,,,other ,not seperately reimbursable,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.95,60,,4.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,8.42,85,,6.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,6.94,70,,5.55,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,3.17,32,,2.54,percent of total billed charges,32% of total billed charges,3.17,8.42,
TETRACAINE 0.5% OPHTHALMIC DROPS - 4 ML,31091366,CDM,250,RC,,,OUTPATIENT,,,18.20,7.28,,,,,,other ,not seperately reimbursable,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.92,60,,8.74,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,15.47,85,,12.38,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,12.74,70,,10.19,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,5.82,32,,4.66,percent of total billed charges,32% of total billed charges,5.82,15.47,
VANCOMYCIN 5 GM VIAL,31091367,CDM,636,RC,J3370,HCPCS,OUTPATIENT,,,26.79,10.72,,2.61,100,,,fee schedule,100% of Aetna fee schedule,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.07,60,,12.86,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,22.77,85,,18.22,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,18.75,70,,15,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,8.57,32,,6.86,percent of total billed charges,32% of total billed charges,2.61,22.77,
JARDIANCE 25 MG TAB,31091368,CDM,250,RC,,,OUTPATIENT,,,21.43,8.57,,,,,,other ,not seperately reimbursable,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.86,60,,10.29,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,18.22,85,,14.58,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,15,70,,12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,6.86,32,,5.49,percent of total billed charges,32% of total billed charges,6.86,18.22,
BUPIVACAINE (MARCAINE) 0.25% - 10 ML SDV,31091369,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
BUPIVACAINE (MARCAINE) 0.25% - 10 ML SDV,31091370,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
BUPIVACAINE/EPI (MARCAINE) 0.25% - 10 ML,31091371,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DEXTROSE 50 % IN WATER - 50 ML SDV,31091372,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
POTASSIUM ACETATE 2 MEQ/ML - 20 ML SDV,31091373,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SODIUM ACETATE 2 MEQ/ML - 50 ML MDV,31091374,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
SODIUM CHLORIDE 23.4% - HYPERTONIC - 30,31091375,CDM,636,RC,J7131,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
TDVAX - 0.5 ML SDV,31091376,CDM,636,RC,90714,HCPCS,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
PROPOFOL 500 MG/50 ML,31091377,CDM,636,RC,J2704,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
"BAD NUMBER ,USE 31092044",31092004,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DONNATAL TAB,31092010,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
HYOSCYAMINE ER TABLET: 0.375MG,31092011,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LEVSINEX TIMECAPS,31092012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
HYOSCYAMINE DROPS 0.125MG/ML:15ML,31092013,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
PAVABID CAPSULE:150 MG EQ,31092014,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
HYOSCYAMINE 0.125MG TAB:0.125MG,31092015,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
QUININE SULFATE 260MG:260MG,31092016,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
HYOSCYAM ELIXIR 0.125MG/5ML:5ML,31092017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
OXYBUTYNIN ER 5 MG TABLET,31092019,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
OXYBUTYNIN 5 MG TABLET,31092020,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DETROL TAB:2MG,31092021,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
FLAVOXATE 100MG TAB:100 MG,31092022,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TOLTERODINE ER 4MG CAP,31092023,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DONNATAL ELIXIR: 1 OZ,31092024,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
DETROL-LA 2MG CAP:2MG,31092025,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
AMINOPHYLLIN SUPP:500MG,31092033,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
AMINOPHYLLIN INJ:250MG/10ML,31092035,CDM,636,RC,J0280,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
AMINOPHYLLINE 500 MG/20 ML SDV,31092036,CDM,636,RC,J0280,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
THEOPHYLLINE IV DRIP/D5W 400MG/500ML,31092037,CDM,636,RC,J2810,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
AMINOPHYLLINE 500MG/NS 500ML,31092038,CDM,636,RC,J0280,HCPCS,OUTPATIENT,,,225.00,90.00,,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135,60,,108,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,157.5,70,,126,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,191.25,
UNIPHYL 400MG DAILY TAB:400MG,31092041,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
UNIPHYL 600MG DAILY TAB:600MG,31092042,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
THEO-DUR TAB:100 MG,31092043,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
THEOPHYLLINE ER 300MG TAB 300MG,31092044,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
THEOPHYLLINE IV BOLUS:200MG/50ML IV,31092045,CDM,636,RC,J2810,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
THEOPHYLLINE IV BOLUS:400MG/100ML,31092046,CDM,636,RC,J2810,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
DALIRESP 500MCG TAB,31092047,CDM,250,RC,,,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
THEOPHYLLINE/EL:80MG/15CC,31092050,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AMINOPHYLLIN SUPP:250 MG,31092060,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DONNATAL EL EQUIV:5ML,31092524,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
SLO-PHYLLIN-80LIQ:5ML EQ,31092550,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
NICOBID CAPSULE:125 MG EQ,31093004,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
K-PHOS NEUTRAL TAB:TAB,31093017,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MAGNESIUM OXIDE 400 MG TABLET,31093018,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SLOW-MAG TAB: 5.3MEQ,31093019,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ZINC GLUCONATE 50MG TAB:50MG,31093020,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ZINC SULFATE 220MG CAPSULE,31093021,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEUTRA-PHOS:250MG CA,31093022,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NIACIN SR: 250MG,31093023,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NIASPAN 500MG ER TAB,31093024,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
NEUTRA-PHOS PKT 1.25GM:PKT,31093025,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FERRLECIT 62.5MG/5ML AMP,31093033,CDM,636,RC,J2916,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
VENOFER 100 MG/5 ML SDV,31093034,CDM,250,RC,J1756,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
THER-M BAD# USE 31093113,31093035,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
IRON DEXTRAN 100 MB,31093036,CDM,636,RC,J1750,HCPCS,OUTPATIENT,,,165.00,66.00,,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,60,,79.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,115.5,70,,92.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,32,,42.24,percent of total billed charges,32% of total billed charges,52.8,140.25,
THERA-PLUS LIQ VIT:5MLS,31093037,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
THERAGRAN-BAD# USE31093113,31093038,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
INJECTAFER 750MG SDV,31093040,CDM,636,RC,J1439,HCPCS,OUTPATIENT,,,1.13,0.45,,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,60,,0.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.96,85,,0.77,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.79,70,,0.63,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,0.96,
ASCORBIC ACID 250MG:250MG,31093042,CDM,250,RC,,,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
PHYTONADIONE 10MG/ML AMPULE,31093043,CDM,636,RC,J3430,HCPCS,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
MEPHYTON 5MG ORAL TAB:5MG,31093044,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
ALPHANINE 1020 UNITS:CHG PER UNIT,31093045,CDM,636,RC,J7193,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FOLIC ACID 50 MG/10 ML MDV - PER 1 MG,31093051,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VITAMIN B-12 100MCG TAB:100MCG,31093052,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VITAMIN B-12 1000 MCG/ML SDV,31093053,CDM,636,RC,J3420,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
BETA-CAROTENE CAPSULE: 25MU,31093054,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
VITAMIN B-12 250MCG TAB,31093055,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
VITAMIN B-12 1000 MCG TABLET,31093056,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
THIAMINE 200 MG/2 ML MDV,31093057,CDM,636,RC,J3411,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
THIAMINE 100MG/NS 25ML IVPB,31093058,CDM,636,RC,J3411,HCPCS,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,75.65,
"VITAMIN D3 25 MCG (1,000 UNITS)GEL(N/A)",31093060,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ASCORBIC ACID 500 MG TABLET,31093061,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
"VITAMIN D 50,000 UNITS:50,000 UNITS",31093064,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
NIACIN TABLET:50MG,31093065,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
VITAMIN E CAP:400 IU,31093066,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
VITAMIN E CAP:200IU,31093067,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
THIAMINE 100 MG TABLET,31093070,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PNEUMONIA 13 PREVNAR,31093071,CDM,636,RC,90670,HCPCS,OUTPATIENT,,,261.00,104.40,,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.6,60,,125.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,182.7,70,,146.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,221.85,
PNEUMONIA 23 (PNEUMOVAX),31093072,CDM,636,RC,90732,HCPCS,OUTPATIENT,,,133.00,53.20,,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.8,60,,63.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,93.1,70,,74.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,32,,34.05,percent of total billed charges,32% of total billed charges,42.56,113.05,
FLUZONE HD,31093073,CDM,636,RC,90662,HCPCS,OUTPATIENT,,,62.00,24.80,,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.2,60,,29.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,43.4,70,,34.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,32,,15.87,percent of total billed charges,32% of total billed charges,19.84,87.43,
FLU VACCINE  FLUARIX QUAD,31093074,CDM,636,RC,90686,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,26.9,
POLY-VI-FLOR DR:50ML,31093088,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
POLY-VI-SOL DROPS:30ML,31093089,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
PHYTONADIONE 1MG/0.5ML AMP,31093098,CDM,636,RC,J3430,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
MVI-12 UNIT VIAL 10ML-0,31093107,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
MVI-INFUVITE COMBO DOSE 10ML,31093108,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
HEMOCYTE PLUS 106/1MG TAB,31093112,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MULTIVITAMIN TABLET,31093113,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MULTIVIT CHEWABLE:MVI PO CHEW,31093114,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GLUCERNA 1.5CAL/ML TF 1000ML RTH,31093127,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
NEPRO 240ML:240ML,31093128,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
OSMOLITE HN UNIT 100 ML,31093129,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
ENSURE:240 ML,31093130,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
OSMOLITE:240ML,31093131,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
JEVITY:240 ML(CHG TO 1.5CAL/ML 10/20/10),31093132,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SUPLENA:240ML,31093133,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
PULMOCARE:240ML,31093134,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
VITAL-HN PKT,31093135,CDM,250,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
GLUCERNA 240ML (NOT TUBE FEEDING),31093136,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ENSURE PLUS HN:240ML,31093137,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
TWOCAL HN - 237 ML CARTON,31093138,CDM,250,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
PROCALAMINE 3%,31093139,CDM,250,RC,,,OUTPATIENT,,,220.00,88.00,,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,60,,105.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,154,70,,123.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,32,,56.32,percent of total billed charges,32% of total billed charges,70.4,187,
PRO-MOD POWDER:291GM,31093140,CDM,250,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
GLUCERNA 1.2CAL 1000ML TF:1000ML,31093141,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
JEVITY 1.5CAL 240ML,31093142,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
JEVITY 1.5 CAL - 1000 ML BOTTLE,31093143,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
BOOST VANILLA:240ML,31093144,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
BOOST CHOC:240ML,31093145,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PERATIVE 240ML:240ML,31093146,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PULMOCARE 1000 RTH:1000ML,31093147,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
PERATIVE RTH 1000ML:1000ML,31093148,CDM,250,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
RESOURCE ORANGE 240ML:240ML,31093149,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
NOVASOURCE RENAL TF  240ML:240ML,31093150,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NOVASOURCE RENAL 1000ML:1000ML TF,31093151,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
JEVITY 1.5CAL/ML TF:1500ML,31093152,CDM,250,RC,,,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
TWOCAL  1000ML TF:1000ML,31093153,CDM,250,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
JEVITY 1.0 CAL - 240 ML CARTON,31093154,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
GLUCERNA 1.2 KCAL:240 ML,31093160,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
GLUCERNA 1.0 KCAL 240 ML,31093161,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MULTIVIT LIQUID 15ML DOSE:MVI,31093220,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
GLUCERNA 1.0CAL 1000ML TF:1000ML,31093241,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
COLCHICINE 0.6 MG TABLET,31094002,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
SINEMET EQ 10/100 TAB:10/100,31094004,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CARBIDOPA/L-DOPA TAB 25/250MG,31094005,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CARBAMAZEPINE TAB:200MG,31094007,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ALLOPURINOL 100 MG TABLET,31094008,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
carBAMazepine 100 MG CHEWABLE TABLET,31094009,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TEGRETOL SUSP: 100MG/5ML,31094010,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
TRILEPTAL 150MG TAB:150MG,31094011,CDM,250,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
TRILEPTAL TAB 300MG:300MG,31094012,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
COLCHICINE INJ 1 MG 2 ML,31094013,CDM,250,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
AZATHIOPRINE 50MG TAB,31094014,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CHOLESTYRAMINE 4 GM POWDER PACKET,31094020,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
COLESTID 1GM TAB,31094021,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NEWBORN PHARM ROUTINE CHG,31094045,CDM,250,RC,,,OUTPATIENT,,,98.00,39.20,,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.8,60,,47.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,68.6,70,,54.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,32,,25.09,percent of total billed charges,32% of total billed charges,31.36,83.3,
DAKIN'S 0.5% - FULL STRENGTH,31094060,CDM,250,RC,,,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
MAGNESIUM SULFATE:1 LB,31094061,CDM,250,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
HYDROGEN PEROXIDE,31094062,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
SSRI,31094065,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
BLOOD GLUCOSE MONITORING,31094066,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,12.21,272,,,fee schedule,272% of BCBS fee schedule,12.21,272,,,fee schedule,272% of BCBS fee schedule,12.21,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,6.3,43.35,
NULYTELY 4000 ML BOTTLE,31094067,CDM,250,RC,,,OUTPATIENT,,,34.75,13.90,,,,,,other ,not seperately reimbursable,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.85,60,,16.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,29.54,85,,23.63,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,24.33,70,,19.46,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,11.12,32,,8.9,percent of total billed charges,32% of total billed charges,11.12,29.54,
GO LYTELY EQUIV,31094068,CDM,250,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
HALFLYTELY BOWEL PREP:HALFLYTELY,31094069,CDM,250,RC,,,OUTPATIENT,,,126.00,50.40,,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,60,,60.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,88.2,70,,70.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,32,,32.26,percent of total billed charges,32% of total billed charges,40.32,107.1,
ROPINIROLE 2MG TAB:2MG,31094075,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
PRAMIPEXOLE DIHCL 0.25MG:0.25MG,31094076,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CARBIDOPA/LEVODOPA 25 MG/100 MG TABLET,31094077,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SINEMET CR TAB:50/200,31094078,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
ELDEPRYL TAB: 5MG,31094079,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
CARBIDOPA/L-DOPA ER 25/100 TAB,31094080,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MIRAPEX 0.125MG TAB:0.125MG,31094081,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PRAMIPEXOLE 0.5 MG TABLET,31094082,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
rOPINIRole 0.25 MG TABLET,31094083,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
rOPINIRole 1 MG TABLET,31094084,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ALLOPURINOL 300 MG TABLET,31094085,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
K-Y JELLY:2 OZ,31094086,CDM,250,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
LACTULOSE 20 GM/30 ML - UNIT DOSE CUP,31094087,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
LACTULOSE 10GM/15ML:15ML,31094088,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SORBITOL 70% 30ML:30ML,31094089,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
PRAMIPEXOLE 0.25MG TAB,31094090,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
PRAMIPEXOLE 1MG TAB,31094091,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LOPID CAPSULE: 300MG,31094102,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MAGNESIUM CITRATE - 296 ML BOTTLE,31094103,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METHERGINE TABLET:0.2MG,31095001,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
INTRALIPID 10% 500ML W/ TUBING,31095002,CDM,250,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
INTRALIPIDS 20% IV: 500ML EQ,31095003,CDM,250,RC,,,OUTPATIENT,,,191.00,76.40,,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.6,60,,91.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,162.35,
NICORETTE GUM 2MG BOX,31095004,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
CALCITRIOL 0.25 MCG CAPSULE,31095005,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
SYNTOCINON INJ:10 1 ML,31095006,CDM,250,RC,,,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
METHERGINE INJ 0.2MG/1 ML,31095007,CDM,636,RC,J2210,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
INTRALIPID 20% 250 ML BAG,31095008,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
INTRALIPIDS 10% IV: 250ML,31095009,CDM,250,RC,,,OUTPATIENT,,,136.00,54.40,,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,115.6,
CALCITONIN INJ 200IU/ML 2ML VIAL,31095010,CDM,636,RC,J0630,HCPCS,OUTPATIENT,,,103.50,41.40,,,,,,other ,not seperately reimbursable,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.1,60,,49.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,87.98,85,,70.38,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,72.45,70,,57.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,33.12,32,,26.5,percent of total billed charges,32% of total billed charges,33.12,87.98,
CALCITONIN 200UNITS/SP:3.7ML,31095011,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CALCIMER:400 UNITS,31095012,CDM,250,RC,,,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,204,
LINDANE SHMPOO 1% 60ML:60ML,31095013,CDM,250,RC,,,OUTPATIENT,,,254.00,101.60,,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.4,60,,121.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,177.8,70,,142.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,32,,65.02,percent of total billed charges,32% of total billed charges,81.28,215.9,
LACTINEX GRANULES:1 PKT,31095014,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
LYMPHAZURIN 1% AMPULE,31095015,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,225.00,90.00,,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135,60,,108,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,157.5,70,,126,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,32,,57.6,percent of total billed charges,32% of total billed charges,72,191.25,
LACTAID TABLETS,31095016,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NICODERM 7MG PATCH,31095017,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
NICOTINE 14MG PATCH,31095018,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NICOTINE 21 MG/24 HOURS PATCH,31095019,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
INSPIREASE SPACER DEVICE,31095020,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
AEROCHAMBER FOR MDI,31095021,CDM,250,RC,,,OUTPATIENT,,,141.00,56.40,,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,119.85,
PANCRELIPASE 8000 UNITS:8000 UNITS,31095022,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
EVISTA 60 MG TABLET,31095023,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
PANCRELIPASE 5000UNITS CAP:5000 UNITS,31095024,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
LIPOSYN 10% 200ML IV:200ML,31095025,CDM,250,RC,,,OUTPATIENT,,,261.00,104.40,,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.6,60,,125.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,182.7,70,,146.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,221.85,
LIPOSYN 20% 200ML IV:200ML,31095026,CDM,250,RC,,,OUTPATIENT,,,261.00,104.40,,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.6,60,,125.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,182.7,70,,146.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,221.85,
NIX 1% CREME 60ML:60ML,31095027,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
NICOTINE 7MG PATCH:7MG,31095030,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
RABIES IMMUNE GLOB * OBSOLETE CHK PRICE,31095036,CDM,636,RC,90376,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
CEFEPIME 2 GM SDV,31095037,CDM,636,RC,J0692,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
ELIQUIS 5 MG TABLET,31095038,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
CEFUR0XIME 10MG/ML  0.5ML PREFILLED SYG,31095039,CDM,250,RC,,,OUTPATIENT,,,9.50,3.80,,,,,,other ,not seperately reimbursable,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.7,60,,4.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,8.08,85,,6.46,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,6.65,70,,5.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,3.04,32,,2.43,percent of total billed charges,32% of total billed charges,3.04,8.08,
DEXAMETHASONE 4 MG TABLET,31095040,CDM,250,RC,,,OUTPATIENT,,,5.95,2.38,,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.57,60,,2.86,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,5.06,85,,4.05,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,4.17,70,,3.34,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,5.06,
MOXIFLOXACIN 1.5ML/ BSS 3.5ML OPTH SYR,31095041,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
BETAMETHASONE VALERATE CREAM 0.1% - 15GM,31095042,CDM,250,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
NEUPOGEN SINGLEJECT 480MCG/0.8 ML,31095043,CDM,636,RC,J1442,HCPCS,OUTPATIENT,,,1.38,0.55,,,,,,other ,not seperately reimbursable,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.83,60,,0.66,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,1.17,85,,0.94,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,0.97,70,,0.78,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,0.44,32,,0.35,percent of total billed charges,32% of total billed charges,0.44,1.17,
SODIUM BICARBONATE 4.2% SYRINGE,31095044,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
DEXTROSE 25% INFANT PF SYRINGE,31095045,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CATHFLO ACTIVASE 2 MG SDV,31095046,CDM,636,RC,J2997,HCPCS,OUTPATIENT,,,191.00,76.40,,87.43,100,,,fee schedule,100% of Aetna fee schedule,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.6,60,,91.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,162.35,
FLUZONE HD INFLUENZA  2019/2020,31095047,CDM,636,RC,90662,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,87.43,
metOLazone 5 MG TABLET,31095048,CDM,250,RC,,,OUTPATIENT,,,5.77,2.31,,,,,,other ,not seperately reimbursable,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.46,60,,2.77,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,4.9,85,,3.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,4.04,70,,3.23,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,1.85,32,,1.48,percent of total billed charges,32% of total billed charges,1.85,4.9,
FlLUARIX QUADDRAVALENT INFLU 2019/2020,31095049,CDM,636,RC,90686,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,26.9,
TRIAMICNOLONE ACET MD 40MG/ML MDV 10ML,31095050,CDM,636,RC,J3301,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
MIDODRINE 5 MG TABLET,31095051,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
IBUPROFEN 200 MG TABLET,31095052,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LICE TREATMENT COMPLETE KIT,31095053,CDM,250,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
RID SHAMPOO W/COMB 4-0.33% 20Z,31095054,CDM,250,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
SENSORCAINE MPF W/EPI SF 0.75%:30ML,31095055,CDM,250,RC,,,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
AMITRIPTYLINE 50 MG TABLET,31095056,CDM,250,RC,,,OUTPATIENT,,,8.45,3.38,,,,,,other ,not seperately reimbursable,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.07,60,,4.06,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,7.18,85,,5.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,5.92,70,,4.74,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,2.7,32,,2.16,percent of total billed charges,32% of total billed charges,2.7,7.18,
DAPTOmycin 350 MG PF,31095057,CDM,636,RC,J0878,HCPCS,OUTPATIENT,,,117.00,46.80,,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.2,60,,56.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,81.9,70,,65.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,99.45,
INSULIN DRIP - 100U/100 ML NS - PREMIXED,31095058,CDM,250,RC,,,OUTPATIENT,,,39.00,15.60,,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,60,,18.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,27.3,70,,21.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,32,,9.98,percent of total billed charges,32% of total billed charges,12.48,33.15,
METOLAZONE 2.5 MG TABLET,31095059,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
hydrOXYzine 25MG/1ml SDV,31095060,CDM,636,RC,J3410,HCPCS,OUTPATIENT,,,14.75,5.90,,,,,,other ,not seperately reimbursable,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.85,60,,7.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,12.54,85,,10.03,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,10.33,70,,8.26,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,4.72,32,,3.78,percent of total billed charges,32% of total billed charges,4.72,12.54,
LOSARTAN 25 MG TABLET,31095061,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
PREGABALIN 75 MG CAPSULE,31095062,CDM,250,RC,,,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
glipiZIDE ER 2.5 MG TABLET,31095063,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
VERAPAMIL 120 MG TABLET,31095064,CDM,250,RC,,,OUTPATIENT,,,2.50,1.00,,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.5,60,,1.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,2.13,85,,1.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,1.75,70,,1.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,32,,0.64,percent of total billed charges,32% of total billed charges,0.8,2.13,
ZINC SULFATE 220 MG CAPSULE,31095065,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AMERICAINE 20% OINTMENT - 28 GM TUBE,31095066,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
SARS-COV-2 VACCINE 30MCG/0.3ML (PFIZER),31095067,CDM,636,RC,,,OUTPATIENT,,,0.01,0.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,0.01,
SARS-COV-2 VACCINE 100MCG/0.5 ML (MODERN,31095068,CDM,636,RC,,,OUTPATIENT,,,0.01,0.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,0.01,
AMIODARONE 360 MG/200 ML - PREMIXED,31095069,CDM,250,RC,J0282,HCPCS,OUTPATIENT,,,47.53,19.01,,,,,,other ,not seperately reimbursable,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.52,60,,22.82,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,40.4,85,,32.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,33.27,70,,26.62,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,15.21,32,,12.17,percent of total billed charges,32% of total billed charges,15.21,40.4,
IVERMECTIN 3 MG TABLET,31095070,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
REMDESIVIR 100 MG SDV,31095071,CDM,636,RC,C9399,HCPCS,OUTPATIENT,,,650.00,260.00,,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390,60,,312,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,455,70,,364,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,32,,166.4,percent of total billed charges,32% of total billed charges,208,552.5,
WATER FOR INJECTION 2000ML,31095072,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
"COVID-19 VACCINE (PFIZER), 30MCG",31095073,CDM,636,RC,,,OUTPATIENT,,,0.01,0.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,0.01,
"COVID-19 VACCINE (MODERNA), 100MCG",31095074,CDM,636,RC,,,OUTPATIENT,,,0.01,0.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,0.01,
"COVID-19 VACCINE (ASTAZENECA), 5X1010 PA",31095075,CDM,636,RC,,,OUTPATIENT,,,0.01,0.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,0.01,
CLOTRIMAZOLE VAGINAL  CREAM 2%  21GM (3,31095076,CDM,250,RC,,,OUTPATIENT,,,8.81,3.52,,,,,,other ,not seperately reimbursable,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.29,60,,4.23,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,7.49,85,,5.99,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,6.17,70,,4.94,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,2.82,32,,2.26,percent of total billed charges,32% of total billed charges,2.82,7.49,
CLOTRIMAZOLE VAGINAL CREAM 1% 45GM 7Day,31095077,CDM,250,RC,,,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
"COVID-19 VACCINE (JANSSEN-J&J),  5X1010",31095078,CDM,636,RC,,,OUTPATIENT,,,0.01,0.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,0.01,
Fluarix Quadrivalent 2020/2021,31095079,CDM,636,RC,90686,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,26.9,
FLUZONE HI DOSE QUAD 2020/2021,31095080,CDM,636,RC,90662,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,87.43,
PREVNAR 13,31095081,CDM,636,RC,90670,HCPCS,OUTPATIENT,,,266.00,106.40,,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
PNEUMOVAX 23,31095082,CDM,636,RC,90732,HCPCS,OUTPATIENT,,,139.00,55.60,,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.4,60,,66.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,97.3,70,,77.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,118.15,
SERTALINE 25 MG TABLET,31095083,CDM,250,RC,,,OUTPATIENT,,,13.55,5.42,,,,,,other ,not seperately reimbursable,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.13,60,,6.5,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,11.52,85,,9.22,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,9.49,70,,7.59,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,4.34,32,,3.47,percent of total billed charges,32% of total billed charges,4.34,11.52,
SUBOXONE 8 MG/2 MG SL FILM,31095084,CDM,250,RC,J0574,HCPCS,OUTPATIENT,,,16.20,6.48,,,,,,other ,not seperately reimbursable,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.72,60,,7.78,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,13.77,85,,11.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,11.34,70,,9.07,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,5.18,32,,4.14,percent of total billed charges,32% of total billed charges,5.18,13.77,
DAPTOmycin  500 MG PF SDV,31095085,CDM,636,RC,J0878,HCPCS,OUTPATIENT,,,51.14,20.46,,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.68,60,,24.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,43.47,85,,34.78,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,35.8,70,,28.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,32,,13.09,percent of total billed charges,32% of total billed charges,16.36,43.47,
MESALAMINE 400 MG DR CAPSULE,31095086,CDM,250,RC,,,OUTPATIENT,,,9.99,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.99,60,,4.79,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.49,85,,6.79,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,6.99,70,,5.59,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.49,
BUDESONIDE 3 MG ENTERIC COATED CAPSULE,31095087,CDM,250,RC,,,OUTPATIENT,,,6.69,2.68,,,,,,other ,not seperately reimbursable,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.01,60,,3.21,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.68,40,,2.14,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,5.69,85,,4.55,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,4.68,70,,3.74,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,2.14,32,,1.71,percent of total billed charges,32% of total billed charges,2.14,5.69,
BOOSTRIX (Tdap),31095088,CDM,636,RC,90715,HCPCS,OUTPATIENT,,,58.81,23.52,,,,,,other ,not seperately reimbursable,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.29,60,,28.23,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,49.99,85,,39.99,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,41.17,70,,32.94,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,18.82,32,,15.06,percent of total billed charges,32% of total billed charges,18.82,49.99,
NYSTATIN CREAM - 30 GM TUBE,31095089,CDM,250,RC,,,OUTPATIENT,,,11.24,4.50,,,,,,other ,not seperately reimbursable,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.74,60,,5.39,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,9.55,85,,7.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,7.87,70,,6.3,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,3.6,32,,2.88,percent of total billed charges,32% of total billed charges,3.6,9.55,
PROVAYBLUE (METHYLENE BLUE) 1MG,31095090,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,32.20,12.88,,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.32,60,,15.46,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,27.37,85,,21.9,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,22.54,70,,18.03,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,32,,8.24,percent of total billed charges,32% of total billed charges,10.3,27.37,
TETRACAINE OPHTHALMIC SOLN 0.5% 5ML BTL,31095091,CDM,250,RC,,,OUTPATIENT,,,42.41,16.96,,,,,,other ,not seperately reimbursable,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.45,60,,20.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,36.05,85,,28.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,29.69,70,,23.75,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,13.57,32,,10.86,percent of total billed charges,32% of total billed charges,13.57,36.05,
COMBIVENT 20MCG/100MCG,31095092,CDM,250,RC,,,OUTPATIENT,,,475.00,190.00,,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,32,,121.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285,60,,228,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,32,,121.6,percent of total billed charges,32% of total billed charges,332.5,70,,266,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,403.75,
diazePAM 5 MG/ML CARP SYR *BAD NUMBER*,31095093,CDM,636,RC,J3360,HCPCS,OUTPATIENT,,,34.68,13.87,,,,,,other ,not seperately reimbursable,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.81,60,,16.65,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,29.48,85,,23.58,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,24.28,70,,19.42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,11.1,32,,8.88,percent of total billed charges,32% of total billed charges,11.1,29.48,
REGEN-COV 600 MG/600 MG/10ML (1200),31095094,CDM,636,RC,J3360,HCPCS,OUTPATIENT,,,0.01,0.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OLUMIANT 2 MG TABLET,31095095,CDM,250,RC,,,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
fentaNYL 250 MCG/5 ML SDV,31095096,CDM,636,RC,J3010,HCPCS,OUTPATIENT,,,6.12,2.45,,,,,,other ,not seperately reimbursable,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.67,60,,2.94,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,5.2,85,,4.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,4.28,70,,3.42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,1.96,32,,1.57,percent of total billed charges,32% of total billed charges,1.96,5.2,
DILAUDID 0.5 MG/0.5 ML,31095097,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,7.56,3.02,,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.54,60,,3.63,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,6.43,85,,5.14,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,5.29,70,,4.23,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,6.43,
AMOXICILLIN/CLAVULANATE K 250/62.5/5ML,31095098,CDM,250,RC,,,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
OCTREOTIDE INJ 1000 MCG/ML 1ML,31095099,CDM,250,RC,J2354,HCPCS,OUTPATIENT,,,25.67,10.27,,,,,,other ,not seperately reimbursable,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.4,60,,12.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,21.82,85,,17.46,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,17.97,70,,14.38,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,8.21,32,,6.57,percent of total billed charges,32% of total billed charges,8.21,21.82,
OCTREOTIDE INJ 50 MCG/ML,31095100,CDM,250,RC,J2354,HCPCS,OUTPATIENT,,,15.36,6.14,,,,,,other ,not seperately reimbursable,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.22,60,,7.38,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,13.06,85,,10.45,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,10.75,70,,8.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,4.92,32,,3.94,percent of total billed charges,32% of total billed charges,4.92,13.06,
"VITAMIN D3 50 MCG (2,000 UNITS) TABLETS",31095101,CDM,250,RC,,,OUTPATIENT,,,5.19,2.08,,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.11,60,,2.49,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,4.41,85,,3.53,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,3.63,70,,2.9,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,32,,1.33,percent of total billed charges,32% of total billed charges,1.66,4.41,
HYOSCYAMINE 0.125 MG ORAL #100,31095102,CDM,250,RC,,,OUTPATIENT,,,21.01,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.61,60,,10.09,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.86,85,,14.29,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.71,70,,11.77,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.86,
HYOSCYAMINE 0.125 MG ODT,31095103,CDM,250,RC,,,OUTPATIENT,,,5.16,2.06,,,,,,other ,not seperately reimbursable,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.1,60,,2.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,4.39,85,,3.51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,3.61,70,,2.89,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,1.65,32,,1.32,percent of total billed charges,32% of total billed charges,1.65,4.39,
ZIPRASIDONE 20 MG/ML SDV,31095104,CDM,636,RC,J3486,HCPCS,OUTPATIENT,,,23.53,9.41,,,,,,other ,not seperately reimbursable,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.12,60,,11.3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,20,85,,16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,16.47,70,,13.18,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,7.53,32,,6.02,percent of total billed charges,32% of total billed charges,7.53,20,
Flu Vaccine - 2021/22 Fluarix Quad,31095105,CDM,636,RC,90686,HCPCS,OUTPATIENT,,,23.33,9.33,,,,,,other ,not seperately reimbursable,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14,60,,11.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,19.83,85,,15.86,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,16.33,70,,13.06,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,7.47,32,,5.98,percent of total billed charges,32% of total billed charges,7.47,26.9,
Flu Vaccine - 2021/22 Fluzone High Dose,31095106,CDM,636,RC,Q2038,HCPCS,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,62.05,
Flu Vaccine - 2021/22 Flublok Egg Free,31095107,CDM,636,RC,90682,HCPCS,OUTPATIENT,,,73.00,29.20,,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,87.43,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,87.43,
ceFAZolin 10 GM MDV,31095108,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,10.84,4.34,,,,,,other ,not seperately reimbursable,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.5,60,,5.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,9.21,85,,7.37,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,7.59,70,,6.07,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,3.47,32,,2.78,percent of total billed charges,32% of total billed charges,3.47,9.21,
MEROPENEM 500 MG SDV,31095109,CDM,636,RC,J2185,HCPCS,OUTPATIENT,,,7.12,2.85,,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.27,60,,3.42,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,6.05,85,,4.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,4.98,70,,3.98,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,32,,1.82,percent of total billed charges,32% of total billed charges,2.28,6.05,
VENELEX OINTMENT - 56.7 GM TUBE,31095110,CDM,250,RC,,,OUTPATIENT,,,28.59,11.44,,,,,,other ,not seperately reimbursable,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.15,60,,13.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,24.3,85,,19.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,20.01,70,,16.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,9.15,32,,7.32,percent of total billed charges,32% of total billed charges,9.15,24.3,
GADAVIST 10 MMOL/10 ML SYRINGE,31095111,CDM,255,RC,A9585,HCPCS,OUTPATIENT,,,45.72,18.29,,,,,,other ,not seperately reimbursable,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.43,60,,21.94,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,38.86,85,,31.09,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,32,70,,25.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,14.63,32,,11.7,percent of total billed charges,32% of total billed charges,14.63,38.86,
SYMBICORT 160/4.5 6 GM INHALER,31095112,CDM,250,RC,,,OUTPATIENT,,,208.85,83.54,,,,,,other ,not seperately reimbursable,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.31,60,,100.25,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,177.52,85,,142.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,146.2,70,,116.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,66.83,32,,53.46,percent of total billed charges,32% of total billed charges,66.83,177.52,
CALCITONIN 200 U/SPRAY - 30 DOSE BOTTLE,31095113,CDM,250,RC,,,OUTPATIENT,,,36.59,14.64,,,,,,other ,not seperately reimbursable,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.95,60,,17.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,31.1,85,,24.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,25.61,70,,20.49,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,11.71,32,,9.37,percent of total billed charges,32% of total billed charges,11.71,31.1,
POTASSIUM CHLORIDE 40mEq/100mL - PREMIX,31095114,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
KCENTRA PER UNIT,31095115,CDM,636,RC,J7168,HCPCS,OUTPATIENT,,,7.49,3.00,,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.49,60,,3.59,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,6.37,85,,5.1,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,5.24,70,,4.19,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,32,,1.92,percent of total billed charges,32% of total billed charges,2.4,6.37,
"fentaNYL 2,500 MCG/50 ML SDV",31095116,CDM,636,RC,J3010,HCPCS,OUTPATIENT,,,9.69,3.88,,,,,,other ,not seperately reimbursable,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.81,60,,4.65,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,8.24,85,,6.59,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,6.78,70,,5.42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,3.1,32,,2.48,percent of total billed charges,32% of total billed charges,3.1,8.24,
ENTRESTO 24 MG/26 MG TABLET,31095117,CDM,250,RC,,,OUTPATIENT,,,16.85,6.74,,,,,,other ,not seperately reimbursable,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.11,60,,8.09,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,14.32,85,,11.46,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,11.8,70,,9.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,5.39,32,,4.31,percent of total billed charges,32% of total billed charges,5.39,14.32,
COLCHICINE 0.6 MG CAPSULE,31095118,CDM,250,RC,,,OUTPATIENT,,,5.94,2.38,,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,60,,2.85,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,5.05,85,,4.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,4.16,70,,3.33,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,32,,1.52,percent of total billed charges,32% of total billed charges,1.9,5.05,
SANTYL OINTMENT - 30 GRAM TUBE,31095119,CDM,250,RC,,,OUTPATIENT,,,300.00,120.00,,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,60,,144,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,210,70,,168,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,32,,76.8,percent of total billed charges,32% of total billed charges,96,255,
"VITAMIN D3 25 MCG (1,000 UNITS) TABLETS",31095120,CDM,250,RC,,,OUTPATIENT,,,5.04,2.02,,,,,,other ,not seperately reimbursable,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.02,60,,2.42,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,4.28,85,,3.42,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,3.53,70,,2.82,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,1.61,32,,1.29,percent of total billed charges,32% of total billed charges,1.61,4.28,
fentaNYL 100 MCG/2 ML SDV,31095121,CDM,636,RC,J3010,HCPCS,OUTPATIENT,,,5.68,2.27,,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.41,60,,2.73,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,4.83,85,,3.86,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,3.98,70,,3.18,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,32,,1.46,percent of total billed charges,32% of total billed charges,1.82,4.83,
MORPHINE 4 MG/ML SDV,31095122,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,6.88,2.75,,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.13,60,,3.3,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,5.85,85,,4.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,4.82,70,,3.86,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,32,,1.76,percent of total billed charges,32% of total billed charges,2.2,5.85,
ATROPINE 0.4MG/ML 1MG SDV,31095123,CDM,636,RC,J0461,HCPCS,OUTPATIENT,,,10.25,4.10,,,,,,other ,not seperately reimbursable,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.15,60,,4.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,8.71,85,,6.97,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,7.18,70,,5.74,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,3.28,32,,2.62,percent of total billed charges,32% of total billed charges,3.28,8.71,
PRO-STAT - 30 ML PACKET,31095124,CDM,250,RC,,,OUTPATIENT,,,6.24,2.50,,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.74,60,,2.99,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,5.3,85,,4.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,4.37,70,,3.5,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,32,,1.6,percent of total billed charges,32% of total billed charges,2,5.3,
LABETALOL 200MG/40ML MDV- CHARGED PER MG,31095125,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
diphenhydrAMINE 12.5 MG/5 ML UNIT DOSE C,31095126,CDM,250,RC,,,OUTPATIENT,,,1.13,0.45,,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,60,,0.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.96,85,,0.77,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.79,70,,0.63,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,32,,0.29,percent of total billed charges,32% of total billed charges,0.36,0.96,
MYLANTA - 30 ML UNIT DOSED CUP,31095127,CDM,250,RC,,,OUTPATIENT,,,1.96,0.78,,,,,,other ,not seperately reimbursable,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.18,60,,0.94,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,1.67,85,,1.34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,1.37,70,,1.1,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,0.63,32,,0.5,percent of total billed charges,32% of total billed charges,0.63,1.67,
GENTAMICIN 0.1% OINTMENT - 30 GM TUBE,31095128,CDM,250,RC,,,OUTPATIENT,,,68.29,27.32,,,,,,other ,not seperately reimbursable,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.97,60,,32.78,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,58.05,85,,46.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,47.8,70,,38.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,21.85,32,,17.48,percent of total billed charges,32% of total billed charges,21.85,58.05,
DOBUTamine 250 MG/20 ML SDV,31095129,CDM,250,RC,J1250,HCPCS,OUTPATIENT,,,10.58,4.23,,,,,,other ,not seperately reimbursable,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.35,60,,5.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,8.99,85,,7.19,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,7.41,70,,5.93,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,3.39,32,,2.71,percent of total billed charges,32% of total billed charges,3.39,8.99,
OCTREOTIDE 1000 MCG/5 ML MDV,31095130,CDM,250,RC,J2354,HCPCS,OUTPATIENT,,,83.33,33.33,,,,,,other ,not seperately reimbursable,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50,60,,40,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,70.83,85,,56.66,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,58.33,70,,46.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,26.67,32,,21.34,percent of total billed charges,32% of total billed charges,26.67,70.83,
ERYTHROMYCIN 0.5% EYE OINTMENT - 1 GM,31095131,CDM,250,RC,,,OUTPATIENT,,,11.29,4.52,,,,,,other ,not seperately reimbursable,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.77,60,,5.42,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,9.6,85,,7.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,7.9,70,,6.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,3.61,32,,2.89,percent of total billed charges,32% of total billed charges,3.61,9.6,
LORAZEPAM 2 MG/ML -ORAL SOLUTION PER 1ML,31095132,CDM,250,RC,,,OUTPATIENT,,,0.31,0.12,,,,,,other ,not seperately reimbursable,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.19,60,,0.15,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,0.26,85,,0.21,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,0.22,70,,0.18,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,0.1,32,,0.08,percent of total billed charges,32% of total billed charges,0.1,0.26,
BEER - 12 OUNCE CAN,31095133,CDM,250,RC,,,OUTPATIENT,,,1.08,0.43,,,,,,other ,not seperately reimbursable,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.65,60,,0.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,0.92,85,,0.74,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,0.76,70,,0.61,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,0.35,32,,0.28,percent of total billed charges,32% of total billed charges,0.35,0.92,
ALENDRONATE 70 MG TABLET,31095134,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MIDAZOLAM 50 MG/10 ML MDV,31095135,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,7.36,2.94,,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.42,60,,3.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,6.26,85,,5.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,5.15,70,,4.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,6.26,
DILTIAZEM 30 Mg-n/a Only tabs are 60mg,31095136,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ALPHAGAN-P 0.1% EYE DROPS - 5 ML BOTTLE,31095137,CDM,250,RC,,,OUTPATIENT,,,175.60,70.24,,,,,,other ,not seperately reimbursable,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.36,60,,84.29,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,149.26,85,,119.41,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,122.92,70,,98.34,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,56.19,32,,44.95,percent of total billed charges,32% of total billed charges,56.19,149.26,
ROFLUMILAST 500 MCG TABLET,31095138,CDM,250,RC,,,OUTPATIENT,,,6.44,2.58,,,,,,other ,not seperately reimbursable,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.86,60,,3.09,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,5.47,85,,4.38,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,4.51,70,,3.61,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,2.06,32,,1.65,percent of total billed charges,32% of total billed charges,2.06,5.47,
ORBACTIV PER 10MG 400MG SDV,31095139,CDM,636,RC,J2407,HCPCS,OUTPATIENT,,,1263.00,505.20,,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,757.8,60,,606.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,884.1,70,,707.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,32,,323.33,percent of total billed charges,32% of total billed charges,404.16,1073.55,
MERCAPTOPURINE 50 MG TABLET,31095140,CDM,636,RC,S0108,HCPCS,OUTPATIENT,,,6.75,2.70,,,,,,other ,not seperately reimbursable,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.05,60,,3.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,5.74,85,,4.59,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,4.73,70,,3.78,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,2.16,32,,1.73,percent of total billed charges,32% of total billed charges,2.16,5.74,
CYPROHEPTADINE 4 MG TABLET,31095141,CDM,250,RC,,,OUTPATIENT,,,5.59,2.24,,,,,,other ,not seperately reimbursable,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.35,60,,2.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,4.75,85,,3.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,3.91,70,,3.13,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,1.79,32,,1.43,percent of total billed charges,32% of total billed charges,1.79,4.75,
JEVITY 1.5 CAL 237 ML CARTON,31095142,CDM,250,RC,B4152,HCPCS,OUTPATIENT,,,5.44,2.18,,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.26,60,,2.61,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,0.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,4.62,85,,3.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,3.81,70,,3.05,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,1.74,32,,1.39,percent of total billed charges,32% of total billed charges,0.63,4.62,
FARXIGA 10 MG TABLET,31095143,CDM,250,RC,,,OUTPATIENT,,,22.80,9.12,,,,,,other ,not seperately reimbursable,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.68,60,,10.94,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,19.38,85,,15.5,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,15.96,70,,12.77,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,7.3,32,,5.84,percent of total billed charges,32% of total billed charges,7.3,19.38,
MORPHINE 5 MG/10 ML SDV,31095144,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,12.74,5.10,,,,,,other ,not seperately reimbursable,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.64,60,,6.11,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,10.83,85,,8.66,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,8.92,70,,7.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,4.08,32,,3.26,percent of total billed charges,32% of total billed charges,4.08,10.83,
ACYCLOVIR 5% OINTMENT 15 GM TUBE,31095145,CDM,250,RC,,,OUTPATIENT,,,22.29,8.92,,,,,,other ,not seperately reimbursable,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.37,60,,10.7,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,18.95,85,,15.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,15.6,70,,12.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,7.13,32,,5.7,percent of total billed charges,32% of total billed charges,7.13,18.95,
AMINOPHYLLINE 500 MG/20 ML SDV,31095146,CDM,636,RC,J0280,HCPCS,OUTPATIENT,,,13.68,5.47,,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.21,60,,6.57,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,11.63,85,,9.3,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,9.58,70,,7.66,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,32,,3.5,percent of total billed charges,32% of total billed charges,4.38,11.63,
MEROPENEM 1 GM SDV,31095147,CDM,250,RC,J2185,HCPCS,OUTPATIENT,,,11.69,4.68,,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.01,60,,5.61,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,9.94,85,,7.95,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,8.18,70,,6.54,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,32,,2.99,percent of total billed charges,32% of total billed charges,3.74,9.94,
EDARBI 80 MG TABLET,31095148,CDM,250,RC,,,OUTPATIENT,,,13.93,5.57,,,,,,other ,not seperately reimbursable,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.36,60,,6.69,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,11.84,85,,9.47,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,9.75,70,,7.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,4.46,32,,3.57,percent of total billed charges,32% of total billed charges,4.46,11.84,
MYRBETRIQ ER 25 MG TABLET,31095149,CDM,250,RC,,,OUTPATIENT,,,22.16,8.86,,,,,,other ,not seperately reimbursable,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.3,60,,10.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,18.84,85,,15.07,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,15.51,70,,12.41,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,7.09,32,,5.67,percent of total billed charges,32% of total billed charges,7.09,18.84,
OXCARBAZEPINE 600 MG TABLET,31095150,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
MEDIHONEY 1.5 OZ DRESSING,31095151,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
STREPTOMYCIN 1 GM SDV,31095152,CDM,250,RC,J3000,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
CEFAZOLIN 2 GM SDV,31095153,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
PAwsome Sauce - R.E.C.K. 50 ML PF SYRING,31095154,CDM,250,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
STERILE WATER FOR IRRIGATION - 250 ML BO,31095155,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NEBIVOLOL 20 MG TABLETS,31095156,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AZITHROMYCIN 200 MG/5 ML SUSP -15 ML BTL,31095157,CDM,250,RC,,,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
VIMPAT 100 MG TABLET,31095158,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
MOUNJAR0 5MG/0.5ML,31095159,CDM,250,RC,,,OUTPATIENT,,,1183.00,473.20,,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,709.8,60,,567.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,1005.55,85,,804.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,828.1,70,,662.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,32,,302.85,percent of total billed charges,32% of total billed charges,378.56,1005.55,
RELISTOR 150MG TAB,31095160,CDM,250,RC,,,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
XIFAXIN 550 MG TAB,31095161,CDM,250,RC,,,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
NEBIVOLOL 10 MG TABLET,31095162,CDM,250,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
PROLIA 60 MG/ML SYRINGE,31095163,CDM,636,RC,J0897,HCPCS,OUTPATIENT,,,5190.00,2076.00,,20.11,100,,,fee schedule,100% of Aetna fee schedule,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3114,60,,2491.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,4411.5,85,,3529.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,3633,70,,2906.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,1660.8,32,,1328.64,percent of total billed charges,32% of total billed charges,20.11,4411.5,
ISOSORBIDE DINITRITE 20 MG TABLET,31095164,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
"INJ INFLIXIMAB, EXC BIOSIMILAR, 10 MG",31095165,CDM,636,RC,J1745,HCPCS,OUTPATIENT,,,58.00,23.20,,44.9,100,,,fee schedule,100% of Aetna fee schedule,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,60,,27.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,40.6,70,,32.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,32,,14.85,percent of total billed charges,32% of total billed charges,18.56,49.3,
"INJ PHENYLEPHRINE, 20 MCG",31095166,CDM,250,RC,J2371,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
FLUVOXAMINE 100 MG TABLET,31095167,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ATOMOXETINE 18 MG CAPSULE,31095168,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CEPHALEXIN 250 MG CAPSULE,31095169,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
KCl 40 MEQ/DEXTROSE 5%/NaCL/ 0.9% PER 1K,31095170,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
VANCOMYCIN 125 MG CAPSULE,31095171,CDM,250,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
METHYLPREDNISOLONE 8 MG TABLET,31095172,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GLYDO 2% JELLY 11 ML PREFILLED SYRINGE,31095173,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CLOBETASOL 0.05% ONT 30 GM  TUBE,31095174,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
CLOBETASOL 0.05% ONT 30 GM  TUBE,31095175,CDM,250,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
CLOBETASOL 0.05% ONT 15 GM  TUBE,31095176,CDM,250,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
MYRBETRIQ ER 50 MG TABLETS,31095177,CDM,250,RC,,,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
VANCOMYCIN 25 MG/ML ORAL  SOLN - 300 ML,31095178,CDM,250,RC,,,OUTPATIENT,,,117.00,46.80,,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.2,60,,56.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,81.9,70,,65.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,99.45,
DICLOFENAC 1% TOPICAL GEL 100 GM TB,31095179,CDM,250,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
LEQVIO 284 MG/1.5 ML PREFILLED SYRINGE,31095180,CDM,636,RC,J1306,HCPCS,OUTPATIENT,,,10143.00,4057.20,,,,,,other ,not seperately reimbursable,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6085.8,60,,4868.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,8621.55,85,,6897.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,7100.1,70,,5680.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,3245.76,32,,2596.61,percent of total billed charges,32% of total billed charges,3245.76,8621.55,
EVENITY 210 MG/2.34 ML,31095181,CDM,636,RC,J3111,HCPCS,OUTPATIENT,,,7512.00,3004.80,,,,,,other ,not seperately reimbursable,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4507.2,60,,3605.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,6385.2,85,,5108.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,5258.4,70,,4206.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,2403.84,32,,1923.07,percent of total billed charges,32% of total billed charges,2403.84,6385.2,
CLINIMIX E 5-15% 2000 ML BAG,31095182,CDM,250,RC,,,OUTPATIENT,,,71.00,28.40,,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
MICAFUNGIN 100 MG SDV,31095183,CDM,636,RC,J2247,HCPCS,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
INVEST DRUG,31096700,CDM,250,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,30.6,
PYRIDOXINE 50MG TAB,31097028,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
"ISOPTIN SR: 120 MG, TBCR, 100 EA, BOX",31097030,CDM,250,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
EXPAREL 266 MG/20 ML SDV,31097032,CDM,636,RC,C9290,HCPCS,OUTPATIENT,,,475.00,190.00,,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,32,,121.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285,60,,228,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,32,,121.6,percent of total billed charges,32% of total billed charges,332.5,70,,266,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,32,,121.6,percent of total billed charges,32% of total billed charges,152,403.75,
EXPAREL 133 MG/10 ML SDV,31097033,CDM,636,RC,C9290,HCPCS,OUTPATIENT,,,315.00,126.00,,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,60,,151.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,220.5,70,,176.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,32,,80.64,percent of total billed charges,32% of total billed charges,100.8,267.75,
GLYDO 2% JELLY 6 ML PREFILLED SYRINGE,31097034,CDM,250,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
NS 50 ML SDV,31097035,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
INFLECTRA 100 MG SDV,31097047,CDM,636,RC,Q5103,HCPCS,OUTPATIENT,,,700.00,280.00,,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420,60,,336,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,595,85,,476,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,490,70,,392,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,32,,179.2,percent of total billed charges,32% of total billed charges,224,595,
LACOSAMIDE 150 MG TABLET,31097069,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
LIDOCAINE 1% 50 ML MDV - CHARGED PER ML,31097077,CDM,250,RC,,,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
METHOCARBAMOL 500 MG TABLET,31097078,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ALBUTEROL 25 MG/5 ML INHALATION SOLUTION,31097089,CDM,251,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
CARDENE 20 MG/200 ML PREMIXED BAG,31097148,CDM,250,RC,J2404,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
COSOPT OPHTH 5ML:5ML,31161147,CDM,250,RC,,,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,52,40,,41.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
CPSI ORDER ENTRY NUMBER,31888888,CDM,250,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
STERILE WATER IRR BOTTLE 2F7114:1 L BOTL,32005063,CDM,250,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
SWF IRRIG 1L BAG 2B7114:1000ML BAG,32005064,CDM,250,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
NS IRRIG 1000ML BOT 2F7124:NS 1L IRRIG,32005135,CDM,250,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
INTRAVIA EMPTY IVPB 150ML:150ML,32205001,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
D5-1/4NS 1000 ML - 2B1094,32205004,CDM,258,RC,J7042,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
IV TPN 0.22 SET2C8593:2C8593,32205008,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
IV AMIODARONE VENTSET 2C7575:2C7575,32205009,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
IV 0.22 FILTER SET'OBSOLETE USE 2C8593,32205010,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
IV LIPID SET-2C1145,32205011,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
D5W 1000 ML - 2B0064,32205012,CDM,636,RC,J7070,HCPCS,OUTPATIENT,,,102.00,40.80,,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,60,,48.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,86.7,
D5W 500 ML - 2B0063Q,32205020,CDM,636,RC,J7060,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
D5W 500ML AVIVA 6E0063:D5W AVIVA 500ML,32205021,CDM,636,RC,J7060,HCPCS,OUTPATIENT,,,74.00,29.60,,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
D5-LR 1000 ML - 2B2074,32205038,CDM,636,RC,J7120,HCPCS,OUTPATIENT,,,102.00,40.80,,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,60,,48.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,86.7,
ISOLYTE S IN D5W:1000CC,32205079,CDM,262,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
D5-1/2NS 1000 ML - 2B1074,32205111,CDM,636,RC,J7042,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
D5-1/2NS 500ML 2B1073:D5-1/2NS 500ML,32205129,CDM,636,RC,J7042,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
LR 1000ML LVP 2B2324:LR 1000MLS,32205137,CDM,636,RC,J7120,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
LR 500ML 2B2323 LVP:LR 500ML IV,32205145,CDM,636,RC,J7120,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
D5-NS 1000 ML - 2B1064,32205160,CDM,636,RC,J7042,HCPCS,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
NS 1000ML IV 2B1324:NS 1000ML 2B1324,32205186,CDM,258,RC,J7030,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
NS 500ML IV 2B1323:NS 500ML 2B1323,32205194,CDM,258,RC,J7040,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
D10W 500 ML - 2B0163,32205202,CDM,258,RC,,,OUTPATIENT,,,28.06,11.22,,,,,,other ,not seperately reimbursable,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.84,60,,13.47,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,23.85,85,,19.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,19.64,70,,15.71,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,8.98,32,,7.18,percent of total billed charges,32% of total billed charges,8.98,23.85,
D50W 500ML 2B0264P:500ML,32205203,CDM,258,RC,,,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
D50W 1000ML 2B0266P:1000ML,32205204,CDM,258,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
AA 8.5% 500ML 2B6613:500ML,32205205,CDM,258,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
AA 8.5% 1000ML 2B6614:1000ML,32205206,CDM,258,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
AA 20% (20GM/100ML):100ML,32205207,CDM,258,RC,,,OUTPATIENT,,,170.00,68.00,,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102,60,,81.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,119,70,,95.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,32,,43.52,percent of total billed charges,32% of total billed charges,54.4,144.5,
AA 5.5% 500ML 2B6603:500ML,32205208,CDM,258,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
PPN 2000ML COMPD:2L,32205209,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
CLINIMIX E 2.75/5 PPN 2L:2L,32205210,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX TPN 5/15 2L:2L,32205211,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX TPN 5/20 2L:2L,32205212,CDM,250,RC,,,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
CLINIMIX W/O 2.75/5 PPN 2L:2L,32205213,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX-E 4.25/5 2L:4.25/5 2L,32205214,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX 4.25/5 2L:4.25/5,32205215,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX 4.25/10:2L,32205216,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX-E 4.25/5 1L:4.25/5 1L,32205217,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX 4.25/5 1L 2B7726:4.25/5 1L,32205218,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
LIPOSYN 10% 250ML:250ML,32205219,CDM,250,RC,,,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
BANANA BAG 1L:1L,32205220,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
CLINIMIX TPN 5/20 1L:1L,32205221,CDM,250,RC,,,OUTPATIENT,,,102.00,40.80,,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,60,,48.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,71.4,70,,57.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,32,,26.11,percent of total billed charges,32% of total billed charges,32.64,86.7,
CLINIMIX TPN 5/15 1L:1L,32205222,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
INTRALIPID 20% 100ML:100ML,32205223,CDM,250,RC,,,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
CLINIMIX 4.25/10:1L,32205225,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
D10W 250ML 2B0162:250ML 2B0162,32205226,CDM,258,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
ARGINAID,32205240,CDM,250,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
D5W 250 ML - 2B0062,32206010,CDM,636,RC,J7060,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
D5W 250ML (GLASS) 1A0062:D5W 250ML,32206011,CDM,636,RC,J7060,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
D5W 100 ML - 2B0087,32206036,CDM,258,RC,J7060,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
D5W 150ML 2B0061:D5W 150ML,32206037,CDM,636,RC,J7060,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
DEXTROSE 5% INJ: 50 ML USP,32206044,CDM,258,RC,,,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
D5-1/2NS 250ML:250ML (NON-FORMULARY),32206069,CDM,258,RC,,,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
NS IRRIGATION 250 ML BOTTLE - 2F7122,32206070,CDM,250,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
NS IRRIGATION 500 ML BOTTLE 2F7123,32206071,CDM,272,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
NS 250ML IVPB 2B1322Q:NS 250ML IVPB,32206085,CDM,258,RC,J7050,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
NS 100ML FS 2B1307:100ML 2B1307,32206093,CDM,636,RC,J7030,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
ANTICOAGULANT CITRATE PHOS500C,32207000,CDM,258,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
D20W 1000ML:1000ML,32233256,CDM,258,RC,,,OUTPATIENT,,,95.00,38.00,,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,60,,45.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,66.5,70,,53.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,32,,24.32,percent of total billed charges,32% of total billed charges,30.4,80.75,
ORTHO ELVIS ELIXIR-HIP:200ML,32260001,CDM,250,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
ORTHO ELVIS ELIXIR 100ML,32260002,CDM,250,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
ORTHO ABX IRRIG 3L BAG:3L,32260010,CDM,250,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
ORTHO ABX IRRIG 1L NS BOT:1L 2F7124,32260011,CDM,250,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
ORTHO INSTR SW IRRG 1L  BOT:1L 2F7114,32260012,CDM,250,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
NS 3000ML IRRIG BAG 2B7477:NS 3L IRR,32260015,CDM,250,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
GLYCINE 1.5% 3000ML IRRIG BAG:3000ML,32260016,CDM,250,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
D5W ALCOHOL:1000ML,32260017,CDM,258,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
WATER FOR IRRIGATION 3000ML:3L 2B7117,32260018,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
SORBITOL 3% IRRIG 3000ML:3000ML,32260019,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
LR 3000ML IRRIG BAG:LR IR 3L 2B7487,32260020,CDM,250,RC,,,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
LACTATED RINGERS IRRIG 5000ML:5000ML,32260021,CDM,250,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
GENTRAN 10%-40 & NACL 0.9%:500CC,32261791,CDM,262,RC,,,OUTPATIENT,,,85.00,34.00,,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
DEXTRAN IN 9 PERCENT NACL: 500ML,32261809,CDM,258,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
DEXTROSE 5% IN 0.2% NACL: 250ML,32261817,CDM,636,RC,J7042,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
D5-1/4NS 500ML 2B1093:D5-1/4NS,32261833,CDM,636,RC,J7042,HCPCS,OUTPATIENT,,,86.00,34.40,,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,73.1,
DEXTROSE 5% IN LR: 500ML,32261841,CDM,636,RC,J7121,HCPCS,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
NACL 0.45% 1L 2B1314:1000ML,32265776,CDM,636,RC,J7040,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
NACL 0.45% KCL 40 MEQ 1L:1000ML,32265780,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
NACL 0.45% 500ML 2B1313:500ML,32265784,CDM,636,RC,J7040,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
NACL 3% 500ML 2B1353:500ML HYPERTONIC,32266196,CDM,636,RC,J7131,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
NACL 3% HYPERTONIC:500ML,32266198,CDM,636,RC,J7131,HCPCS,OUTPATIENT,,,83.00,33.20,,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,70.55,
D5W ADVANTAGE : 50 ML,32266204,CDM,258,RC,,,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
D10W 500 ML - 2B1063,32266246,CDM,258,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
KCL 20MEQ/D5LR  2B2224:2B2224,32266251,CDM,258,RC,,,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
KCL 20MEQ/D5W 1L 2B1134:2B1134,32266252,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
KCL 10MEQ/D5&1/2-(1644):2B1644,32266253,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
KCL 20MEQ/D5&1/2(1654):2B1654,32266255,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,139.00,55.60,,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.4,60,,66.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,97.3,70,,77.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,32,,35.58,percent of total billed charges,32% of total billed charges,44.48,118.15,
KCL 20MEQ/NS 1L 2B1764,32266256,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
KCL 40MEQ/NS 1L 2B1984:2B1984,32266257,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
KCL 20MEQ-1/2NS 2B1357,32266258,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
KCL 40/D5 1/2-2B1674:2B1674,32266259,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,143.00,57.20,,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.8,60,,68.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,100.1,70,,80.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,32,,36.61,percent of total billed charges,32% of total billed charges,45.76,121.55,
KCL 10/D5&1/4-2B1604:2B1604,32266260,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
KCL 20 MEQ/D5NS - 2B2434,32266261,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
NS 100ML FOR INSULIN DRIP,32266262,CDM,258,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
NS 50ML IVPB 2B1301:50ML,32266263,CDM,258,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
NS 100ML IVPB 2B1302:NS 100ML,32266264,CDM,636,RC,J7050,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
NS 100ML MNBG+ 2B0043:100ML,32266265,CDM,636,RC,J7050,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
NS 50ML MNBG+ 2B0042:50ML,32266267,CDM,250,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
NS 10ML SDV:10ML,32266268,CDM,250,RC,A4216,HCPCS,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
NS 25ML IVPB 2B1300:NS 25ML,32266269,CDM,258,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
NS 50ML FS 2B1306:50ML 2B1306,32266270,CDM,258,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
MAGNESIUM SO4 4GM/NS 50ML:4GM,32266272,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,117.00,46.80,,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.2,60,,56.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,81.9,70,,65.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,99.45,
MAG SULFATE 4GM/100 BOLUS:4GM/100,32266274,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
MAG SULFATE 20GM/500ML LVP:20GM/500ML,32266275,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,409.00,163.60,,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.4,60,,196.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,347.65,85,,278.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,286.3,70,,229.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,347.65,
MAG SULFATE 40GM/LITER:40GM/L,32266276,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,409.00,163.60,,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.4,60,,196.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,347.65,85,,278.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,286.3,70,,229.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,32,,104.7,percent of total billed charges,32% of total billed charges,130.88,347.65,
MAG SULFATE 1GM/100ML IVPB:1GM,32266277,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
MAGNESIUM SO4 2GM/NS 50ML:2GM,32266278,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,117.00,46.80,,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.2,60,,56.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,81.9,70,,65.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,32,,29.95,percent of total billed charges,32% of total billed charges,37.44,99.45,
PLEURODESIS INJ 60ML :60ML,32266279,CDM,250,RC,,,OUTPATIENT,,,261.00,104.40,,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.6,60,,125.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,182.7,70,,146.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,32,,66.82,percent of total billed charges,32% of total billed charges,83.52,221.85,
FLEBOGAMMA 10% 5GM/50ML:5GM,32266280,CDM,636,RC,J1572,HCPCS,OUTPATIENT,,,894.00,357.60,,36.86,100,,,fee schedule,100% of Aetna fee schedule,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,536.4,60,,429.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,759.9,85,,607.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,625.8,70,,500.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,286.08,32,,228.86,percent of total billed charges,32% of total billed charges,36.86,759.9,
xFLEBOGAMMA 10% 10GM/100ML:10GM/100ML,32266281,CDM,636,RC,J1572,HCPCS,OUTPATIENT,,,1787.00,714.80,,36.86,100,,,fee schedule,100% of Aetna fee schedule,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1072.2,60,,857.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,1518.95,85,,1215.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,1250.9,70,,1000.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,571.84,32,,457.47,percent of total billed charges,32% of total billed charges,36.86,1518.95,
FLEBOGAMMA 35GM 10%:35GM,32266282,CDM,636,RC,J1572,HCPCS,OUTPATIENT,,,71.00,28.40,,36.86,100,,,fee schedule,100% of Aetna fee schedule,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.6,60,,34.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,49.7,70,,39.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,32,,18.18,percent of total billed charges,32% of total billed charges,22.72,60.35,
Ropivacaine 0.5% INJ 5mg/ml 30ml SDV,32266284,CDM,636,RC,J2795,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
levoFLOXacin 500 MG/D5W 100ML  PM,32266285,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,7.56,3.02,,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.54,60,,3.63,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,6.43,85,,5.14,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,5.29,70,,4.23,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,32,,1.94,percent of total billed charges,32% of total billed charges,2.42,6.43,
INJ TETANUS IMMUNE GLOB 250U,32266286,CDM,636,RC,J1670,HCPCS,OUTPATIENT,,,469.00,187.60,,,,,,other ,not seperately reimbursable,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.4,60,,225.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,398.65,85,,318.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,328.3,70,,262.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,150.08,32,,120.06,percent of total billed charges,32% of total billed charges,150.08,398.65,
OXACILLIN SODIUM 10GM PWDR/VIAL,32266287,CDM,636,RC,J2700,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,7.62,272,,,fee schedule,272% of BCBS fee schedule,7.62,272,,,fee schedule,272% of BCBS fee schedule,7.62,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,7.62,44.2,
NEUPOGEN SINGLEJECT 480MCG/0.8 ML,32266288,CDM,636,RC,J1442,HCPCS,OUTPATIENT,,,662.40,264.96,,,,,,other ,not seperately reimbursable,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,397.44,60,,317.95,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,563.04,85,,450.43,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,463.68,70,,370.94,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,211.97,32,,169.58,percent of total billed charges,32% of total billed charges,211.97,563.04,
D10W 1000 ML - 2B0164,32266289,CDM,258,RC,,,OUTPATIENT,,,7.38,2.95,,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.43,60,,3.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,6.27,85,,5.02,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,5.17,70,,4.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,32,,1.89,percent of total billed charges,32% of total billed charges,2.36,6.27,
MRI SHOULDER W/O CONTRAST,32607061,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,1031.00,412.40,,750,100,,,case rate,pays based on per visit rate,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,2031.08,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,618.6,60,,494.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,379.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,876.35,85,,701.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,721.7,70,,577.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,329.92,32,,263.94,percent of total billed charges,32% of total billed charges,329.92,2031.08,
ANES STEROID INJ,33001040,CDM,370,RC,J1040,HCPCS,OUTPATIENT,,,285.00,114.00,,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171,60,,136.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,199.5,70,,159.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,242.25,
ANES PROC INSERTION ARTERIAL LINE,33036620,CDM,361,RC,36620,HCPCS,OUTPATIENT,,,136.00,54.40,,3000,100,,,case rate,pays based on per visit rate,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,60,,65.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,56.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,95.2,70,,76.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,32,,34.82,percent of total billed charges,32% of total billed charges,43.52,3000,
INJ DX/TX SOLN LUMBAR/CAUDIL EPIDURAL,33062311,CDM,360,RC,62322,HCPCS,OUTPATIENT,,,1177.00,470.80,,3000,100,,,case rate,pays based on per visit rate,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,706.2,60,,564.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,1000.45,85,,800.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,823.9,70,,659.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,177.54,3000,
ANES PROC AXILLARY BLOCK,33064417,CDM,370,RC,64417,HCPCS,OUTPATIENT,,,1697.00,678.80,,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1018.2,60,,814.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,175.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,1442.45,85,,1153.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,1187.9,70,,950.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,175.49,1442.45,
ANES CONT INFUSION /CATH,33064448,CDM,370,RC,64448,HCPCS,OUTPATIENT,,,2716.00,1086.40,,,,,,other ,not seperately reimbursable,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1629.6,60,,1303.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,77.98,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,2308.6,85,,1846.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,1901.2,70,,1520.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,869.12,32,,695.3,percent of total billed charges,32% of total billed charges,77.98,2308.6,
ANES CERV/THOR FACET INJ SNGLE,33064470,CDM,370,RC,64490,HCPCS,OUTPATIENT,,,1177.00,470.80,,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,706.2,60,,564.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,240.61,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,1000.45,85,,800.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,823.9,70,,659.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,376.64,32,,301.31,percent of total billed charges,32% of total billed charges,240.61,1000.45,
ANES CERV/THOR FACET INJ ADD'L,33064472,CDM,370,RC,64491,HCPCS,OUTPATIENT,,,185.00,74.00,,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,121.99,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,312,
ANES LUMBAR FACET 1 LEVEL,33064475,CDM,370,RC,64493,HCPCS,OUTPATIENT,,,226.00,90.40,,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,135.6,60,,108.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,219.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,158.2,70,,126.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,32,,57.86,percent of total billed charges,32% of total billed charges,72.32,312,
ANES LUMBAR FACET INJ ADDL,33064476,CDM,370,RC,64494,HCPCS,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,114.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,312,
ANES THORACIS PARAVERTEBRAL INJ,33064520,CDM,370,RC,64520,HCPCS,OUTPATIENT,,,233.00,93.20,,,,,,other ,not seperately reimbursable,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,139.8,60,,111.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,288.44,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,163.1,70,,130.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,74.56,32,,59.65,percent of total billed charges,32% of total billed charges,74.56,312,
ANES EPIDUROGRAPHY,33072275,CDM,370,RC,72275,HCPCS,OUTPATIENT,,,203.00,81.20,,91.01,80,,,fee schedule,80% of Aetna fee schedule,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.8,60,,97.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,142.1,70,,113.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,64.96,32,,51.97,percent of total billed charges,32% of total billed charges,64.96,172.55,
ANES FLUORO/C-ARM SPINE,33077003,CDM,370,RC,77003,HCPCS,OUTPATIENT,,,91.00,36.40,,49.51,80,,,fee schedule,80% of Aetna fee schedule,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,94.04,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,94.04,
ANES SEDATION 1ST 15 MINS <=5YO,33099144,CDM,370,RC,99155,HCPCS,OUTPATIENT,,,339.00,135.60,,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.4,60,,162.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,108.21,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,237.3,70,,189.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.21,288.15,
ANES SEDATION 1ST 15 MINS > 5YO,33099145,CDM,370,RC,99156,HCPCS,OUTPATIENT,,,339.00,135.60,,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.4,60,,162.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,98.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,237.3,70,,189.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,98.79,288.15,
ANES SEDATION EA  ADDNL 15 MINS,33099146,CDM,370,RC,99157,HCPCS,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.58,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
ANESTHESIA FOR CARDIOVERSION,33400002,CDM,370,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
EMER INTUBATION ANESTHESIA,33400077,CDM,370,RC,,,OUTPATIENT,,,252.00,100.80,,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,60,,120.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,176.4,70,,141.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,32,,64.51,percent of total billed charges,32% of total billed charges,80.64,214.2,
AIRWAY NASA 20 FR,33412075,CDM,271,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
RADIAL ARTERY CATH KIT-AK4220,33412082,CDM,272,RC,,,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
TOUHY NEEDLE 17GA-RM1705,33412086,CDM,272,RC,,,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
WHITACARE NEEDLE 25GA-RPPN2547,33412088,CDM,272,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
BLOOD SET WALRUS,33412220,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
SEDATION ANESTHESIA 1ST 1/2 HR,33412221,CDM,370,RC,,,OUTPATIENT,,,339.00,135.60,,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.4,60,,162.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,237.3,70,,189.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,32,,86.78,percent of total billed charges,32% of total billed charges,108.48,288.15,
SEDATION ANESTHESIA ADD'L 1/2 HR,33412222,CDM,370,RC,,,OUTPATIENT,,,210.00,84.00,,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,60,,100.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,147,70,,117.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,32,,53.76,percent of total billed charges,32% of total billed charges,67.2,178.5,
GENERAL ANESTESIA 1ST 1/2 HR,33412223,CDM,370,RC,,,OUTPATIENT,,,1266.00,506.40,,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,759.6,60,,607.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,1076.1,85,,860.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,886.2,70,,708.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,32,,324.1,percent of total billed charges,32% of total billed charges,405.12,1076.1,
GENERAL ANESTESIA ADD'L 1/2 HR,33412231,CDM,370,RC,,,OUTPATIENT,,,496.00,198.40,,,,,,other ,not seperately reimbursable,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.6,60,,238.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,421.6,85,,337.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,347.2,70,,277.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,158.72,32,,126.98,percent of total billed charges,32% of total billed charges,158.72,421.6,
EMERGENCY ANESTHESIA,33412235,CDM,370,RC,,,OUTPATIENT,,,89.00,35.60,,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,75.65,
NEEDLE WHIT 22X3 1/2,33418120,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
STETHESCOPE ESOPHAGEL,33418145,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
AIRWAY NASA 18FR,33418173,CDM,271,RC,,,OUTPATIENT,,,5.61,2.24,,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.37,60,,2.7,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,4.77,85,,3.82,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,3.93,70,,3.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,4.77,
AIRWAY NASA 16FR,33418174,CDM,271,RC,,,OUTPATIENT,,,5.61,2.24,,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.37,60,,2.7,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.24,40,,1.79,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,4.77,85,,3.82,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,3.93,70,,3.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,4.77,
AIRWAY NASA 14FR,33418175,CDM,271,RC,,,OUTPATIENT,,,5.61,2.24,,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.37,60,,2.7,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.24,40,,1.79,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,4.77,85,,3.82,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,3.93,70,,3.14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,32,,1.44,percent of total billed charges,32% of total billed charges,1.8,4.77,
AIRWAY NASO 12FR,33418176,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AIRWAY NASO 22FR,33418177,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AIRWAY NASO 24FR,33418178,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AIRWAY NASO 26FR,33418179,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AIRWAY NASO 28FR,33418180,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AIRWAY NASO 30FR,33418181,CDM,272,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AIRWAY NASO 32FR,33418182,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
AIRWAY NASO 34FR,33418183,CDM,272,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
AIRWAY NASO 36FR,33418184,CDM,272,RC,,,OUTPATIENT,,,10.65,4.26,,,,,,other ,not seperately reimbursable,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.39,60,,5.11,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.26,40,,3.41,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,9.05,85,,7.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,7.46,70,,5.97,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,3.41,32,,2.73,percent of total billed charges,32% of total billed charges,3.41,9.05,
TRAY SPINAL,33418185,CDM,272,RC,,,OUTPATIENT,,,161.00,64.40,,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.6,60,,77.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,112.7,70,,90.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,32,,41.22,percent of total billed charges,32% of total billed charges,51.52,136.85,
MANIFOLD 3PORT,33418187,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SET IV EXT,33418192,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
NEEDLE SPINAL PENCIL POINT 25X31/2,33418198,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
NEEDLE WHITACRE 22X31/2,33418199,CDM,272,RC,,,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
NEEDLE SPINAL 25GX5,33418200,CDM,272,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
WALRUS EXTENTION SET,33418201,CDM,272,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
NEEDLE STIM 21G,33418205,CDM,272,RC,,,OUTPATIENT,,,30.00,12.00,,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12,40,,9.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
NEEDLE STIM 22G,33418206,CDM,272,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
TRAY SPINAL,33418207,CDM,272,RC,,,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
NEEDLE SPINAL 25GX5,33418208,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
NEEDLE SPINAL 25GX6,33418209,CDM,272,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
KIT STIMOPLEX 24X1,33418210,CDM,272,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
NEEDLE STIMUPLEX 22X2,33418211,CDM,272,RC,,,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
NEEDLE STIMUPLEX 22X1 3/8,33418212,CDM,272,RC,,,OUTPATIENT,,,32.00,12.80,,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,60,,15.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,22.4,70,,17.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,32,,8.19,percent of total billed charges,32% of total billed charges,10.24,27.2,
NEEDLE TEFLON 21X4,33418213,CDM,272,RC,,,OUTPATIENT,,,40.00,16.00,,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,60,,19.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16,40,,12.8,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,28,70,,22.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,32,,10.24,percent of total billed charges,32% of total billed charges,12.8,34,
NEEDLE ECHO 22G,33418214,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
NEEDLE ECHO 21G,33418215,CDM,272,RC,,,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
NEEDLE 3.5 NERVCE BLOCK,33418216,CDM,272,RC,,,OUTPATIENT,,,97.00,38.80,,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.2,60,,46.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,67.9,70,,54.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,32,,24.83,percent of total billed charges,32% of total billed charges,31.04,82.45,
NEEDLE STIMUPLEX 22X4,33418217,CDM,272,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
GLIDESCOPE STAT 3,33418218,CDM,272,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
GLIDESCOPE STAT,33418219,CDM,272,RC,,,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
NEEDLE SPINAL PENCIL POINT 24X31/2,33418220,CDM,272,RC,,,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
FLOW DISP SET-STANDARD,33418230,CDM,272,RC,,,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
BREATH BAG 2LITER,33418231,CDM,272,RC,,,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
SUCTION LINER DISP EA,33418236,CDM,271,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
KETAMINE,33418500,CDM,250,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
ZISCONTINUED 010105,33418512,CDM,291,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18,40,,14.4,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
ANESTHESIA MACHINE,33418513,CDM,370,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,62.8,40,,50.24,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
EPIDURAL PROCEDURE,33418523,CDM,370,RC,62322,HCPCS,OUTPATIENT,,,1021.00,408.40,,,,,,other ,not seperately reimbursable,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,612.6,60,,490.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,177.54,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,867.85,85,,694.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,714.7,70,,571.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,326.72,32,,261.38,percent of total billed charges,32% of total billed charges,177.54,867.85,
BLOOD SET,33418524,CDM,272,RC,,,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
EPIDURAL PUMP,33418531,CDM,370,RC,,,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
QUATRO SENSOR,33418532,CDM,272,RC,,,OUTPATIENT,,,66.00,26.40,,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,56.1,
TEMP PROBE,33418534,CDM,370,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
TRAY-SPINAL ANESTHESIA,33418535,CDM,370,RC,,,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
TRAY-SPINAL PENCAN,33418537,CDM,370,RC,,,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24,40,,19.2,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
NEEDLE STIMPULEX 22G,33418539,CDM,370,RC,,,OUTPATIENT,,,44.00,17.60,,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,60,,21.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,30.8,70,,24.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,32,,11.26,percent of total billed charges,32% of total billed charges,14.08,37.4,
NEEDLE ULTRA STEM 22G,33418540,CDM,370,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
INJ ANSTHETIC AGNT AXILLARY NERVE,33418541,CDM,370,RC,64417,HCPCS,OUTPATIENT,,,1697.00,678.80,,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,312,100,,,fee schedule,100% of BCBS ASC tier groupings rate,,,,,other ,not seperately reimbursable,1018.2,60,,814.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,175.49,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,1442.45,85,,1153.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,1187.9,70,,950.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,543.04,32,,434.43,percent of total billed charges,32% of total billed charges,175.49,1442.45,
EXTENSION SET HIGH FLOW/ANES TUBE,33418567,CDM,272,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
NEEDLE BLOCK 22X11/2,33418611,CDM,272,RC,,,OUTPATIENT,,,8.10,3.24,,,,,,other ,not seperately reimbursable,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.86,60,,3.89,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.24,40,,2.59,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,6.89,85,,5.51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,5.67,70,,4.54,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,2.59,32,,2.07,percent of total billed charges,32% of total billed charges,2.59,6.89,
DURAMORPH,33418690,CDM,250,RC,J2274,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
"TX SPEECH, LANGUAGE, VOICE COMM IND 30",34000001,CDM,440,RC,92507,HCPCS,OUTPATIENT,,,199.00,79.60,GN,55.67,80,,,fee schedule,80% of Aetna fee schedule,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.4,60,,95.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,55.67,169.15,
"TX SPEECH, LANGUAGE, VOICE COMM IND 15 M",34000002,CDM,440,RC,92507,HCPCS,OUTPATIENT,,,199.00,79.60,GN,55.67,80,,,fee schedule,80% of Aetna fee schedule,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.4,60,,95.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,96.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,139.3,70,,111.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,63.68,32,,50.94,percent of total billed charges,32% of total billed charges,55.67,169.15,
"TX SPEECH, LANGUAGE, VOICE COMM GRP 2+",34000003,CDM,440,RC,92508,HCPCS,OUTPATIENT,,,59.00,23.60,GN,15.48,80,,,fee schedule,80% of Aetna fee schedule,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.4,60,,28.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,29.51,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,41.3,70,,33.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,18.88,32,,15.1,percent of total billed charges,32% of total billed charges,15.48,50.15,
EVAL SPEECH FLUENCY (STUTTER/CLUTTERING),34000004,CDM,444,RC,92521,HCPCS,OUTPATIENT,,,285.00,114.00,GN,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171,60,,136.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,167.06,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,199.5,70,,159.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,32,,72.96,percent of total billed charges,32% of total billed charges,91.2,242.25,
EVAL SPEECH SOUND PRODUCTION,34000005,CDM,440,RC,92522,HCPCS,OUTPATIENT,,,232.00,92.80,GN,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.2,60,,111.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,140.63,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,197.2,85,,157.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,162.4,70,,129.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,74.24,32,,59.39,percent of total billed charges,32% of total billed charges,74.24,197.2,
BEHAVIORA/QUAL ANALYSIS OF VOICE AND RES,34000006,CDM,440,RC,92524,HCPCS,OUTPATIENT,,,224.00,89.60,GN,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,60,,107.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,138.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,156.8,70,,125.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,32,,57.34,percent of total billed charges,32% of total billed charges,71.68,190.4,
EVAL ORAL PHARYNGEAL SWOLLOW FXN,34000007,CDM,444,RC,92610,HCPCS,OUTPATIENT,,,185.00,74.00,GN,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,60,,88.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,107.29,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,129.5,70,,103.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,32,,47.36,percent of total billed charges,32% of total billed charges,59.2,157.25,
ASSESSMENT OF APHASIA,34000008,CDM,444,RC,96105,HCPCS,OUTPATIENT,,,263.00,105.20,GN,,,,,other ,not seperately reimbursable,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.8,60,,126.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,124.15,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,184.1,70,,147.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,84.16,32,,67.33,percent of total billed charges,32% of total billed charges,84.16,223.55,
DEVELOPMENTAL TEST ADMIN 1st HR,34000009,CDM,918,RC,96112,HCPCS,OUTPATIENT,,,302.00,120.80,,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.2,60,,144.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,160.84,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,211.4,70,,169.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,32,,77.31,percent of total billed charges,32% of total billed charges,96.64,256.7,
DEVELOPMENTAL TEST ADMIN ADDNL 30 MIN,34000010,CDM,918,RC,96113,HCPCS,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,76.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
STANDARDIZED COGNITIVE TESTING PER HR,34000011,CDM,444,RC,96125,HCPCS,OUTPATIENT,,,278.00,111.20,GN,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.8,60,,133.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,130.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,194.6,70,,155.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,88.96,32,,71.17,percent of total billed charges,32% of total billed charges,88.96,236.3,
terminated,35000264,CDM,430,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000265,CDM,430,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000266,CDM,430,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000267,CDM,430,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000268,CDM,430,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000269,CDM,430,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000270,CDM,430,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000271,CDM,430,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000272,CDM,430,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000273,CDM,430,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000274,CDM,430,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMNINATED,35000275,CDM,430,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000276,CDM,430,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000277,CDM,430,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35000278,CDM,430,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
PARAFFIN,35000297,CDM,430,RC,97018,HCPCS,OUTPATIENT,,,55.00,22.00,,7.89,80,,,fee schedule,80% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,7.28,46.75,
ULTRASOUND PER 15 MIN,35000321,CDM,430,RC,97035,HCPCS,OUTPATIENT,,,55.00,22.00,,9.66,80,,,fee schedule,80% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,9.66,46.75,
NEUROMUSCULAR RE-EDUCATION/PER 15 MIN,35000445,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,85.00,34.00,GP,25.12,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,25.12,72.25,
TERMINATED,35001126,CDM,430,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001264,CDM,430,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001265,CDM,430,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001267,CDM,430,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001268,CDM,430,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001269,CDM,430,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001270,CDM,430,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001271,CDM,430,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001272,CDM,430,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001273,CDM,430,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001274,CDM,430,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001275,CDM,430,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001276,CDM,430,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001277,CDM,430,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35001278,CDM,430,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002264,CDM,430,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002265,CDM,430,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002266,CDM,430,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002267,CDM,430,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002268,CDM,430,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002269,CDM,430,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002270,CDM,430,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002271,CDM,430,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002272,CDM,430,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002273,CDM,430,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002274,CDM,430,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002275,CDM,430,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002276,CDM,430,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002277,CDM,430,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35002278,CDM,430,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003264,CDM,430,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003265,CDM,430,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003266,CDM,430,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003267,CDM,430,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003268,CDM,430,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003269,CDM,430,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003270,CDM,430,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003271,CDM,430,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003272,CDM,430,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003273,CDM,430,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003274,CDM,430,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003275,CDM,430,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003276,CDM,430,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003277,CDM,430,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35003278,CDM,430,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004264,CDM,430,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004265,CDM,430,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004266,CDM,430,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004267,CDM,430,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004268,CDM,430,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004269,CDM,430,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004270,CDM,430,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004271,CDM,430,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004272,CDM,430,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004273,CDM,430,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004274,CDM,430,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004275,CDM,430,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004276,CDM,430,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004277,CDM,430,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35004278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005264,CDM,430,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005265,CDM,430,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005266,CDM,430,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005267,CDM,430,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005268,CDM,430,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005269,CDM,430,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005270,CDM,430,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005271,CDM,430,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005272,CDM,430,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005273,CDM,430,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005274,CDM,430,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005275,CDM,430,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005276,CDM,430,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005277,CDM,430,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35005278,CDM,430,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006264,CDM,430,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006265,CDM,430,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006266,CDM,430,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006267,CDM,430,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006269,CDM,430,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006270,CDM,430,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006271,CDM,430,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006273,CDM,430,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006274,CDM,430,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006275,CDM,430,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006276,CDM,430,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006277,CDM,430,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
TERMINATED,35006278,CDM,430,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GOCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OT EVAL LI,35097003,CDM,434,RC,97165,HCPCS,OUTPATIENT,,,219.00,87.60,GO,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.4,60,,105.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,186.15,
OT RE-EVAL,35097004,CDM,434,RC,97168,HCPCS,OUTPATIENT,,,118.00,47.20,GO,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.65,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
OT EVAL LII,35097005,CDM,434,RC,97166,HCPCS,OUTPATIENT,,,219.00,87.60,GO,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.4,60,,105.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,186.15,
OT EVAL LIII,35097006,CDM,434,RC,97167,HCPCS,OUTPATIENT,,,219.00,87.60,GO,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.4,60,,105.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,186.15,
ELECTRICAL STIMULATION UNATTENDED,35097014,CDM,430,RC,97014,HCPCS,OUTPATIENT,,,37.00,14.80,GO,11.91,80,,,fee schedule,80% of Aetna fee schedule,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.71,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
ELECTRICAL STIMULATION ATTENDED,35097032,CDM,430,RC,97032,HCPCS,OUTPATIENT,,,38.00,15.20,GO,14.33,80,,,fee schedule,80% of Aetna fee schedule,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
THERAPEUTIC EXERCISE PER 15 MIN,35097110,CDM,430,RC,97110,HCPCS,OUTPATIENT,,,85.00,34.00,GO,24.1,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,24.1,72.25,
NEUROMUSCULAR RE EDUCATION PER 15 MIN,35097112,CDM,430,RC,97112,HCPCS,OUTPATIENT,,,85.00,34.00,,25.12,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,25.12,72.25,
MASSAGE PER 15 MIN,35097124,CDM,430,RC,97124,HCPCS,OUTPATIENT,,,55.00,22.00,GO,19.6,80,,,fee schedule,80% of Aetna fee schedule,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,60,,26.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,38.5,70,,30.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,32,,14.08,percent of total billed charges,32% of total billed charges,17.6,46.75,
MANUAL THERAPY PER 15 MIN,35097140,CDM,430,RC,97140,HCPCS,OUTPATIENT,,,89.00,35.60,GO,22.54,80,,,fee schedule,80% of Aetna fee schedule,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,22.54,75.65,
ORTHOTIC FITTING & TRAIN PER 15,35097504,CDM,430,RC,97760,HCPCS,OUTPATIENT,,,74.00,29.60,GO,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,60.24,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
PROSTHETICS TRAINING PER 15 MIN,35097520,CDM,430,RC,97761,HCPCS,OUTPATIENT,,,74.00,29.60,GO,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,51.7,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,62.9,
THERAPEUTIC ACTIVITIES PER 15 MIN,35097530,CDM,430,RC,97530,HCPCS,OUTPATIENT,,,85.00,34.00,GO,26.13,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,26.13,72.25,
CONGNITIVE SKILLS DEVELOPMENT PER 15 MIN,35097532,CDM,430,RC,97129,HCPCS,OUTPATIENT,,,85.00,34.00,GO,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,28.96,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
SENSORY INTEGRATIVE TECHNIQUE PER 15 MIN,35097533,CDM,430,RC,97533,HCPCS,OUTPATIENT,,,85.00,34.00,GO,22.05,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,79.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,22.05,79.28,
SELF-CARE HOME MANAGEMENT PER 15 MIN,35097535,CDM,430,RC,97535,HCPCS,OUTPATIENT,,,89.00,35.60,GO,26.14,80,,,fee schedule,80% of Aetna fee schedule,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,26.14,75.65,
COMMUNITY/WORK REINTEGRATION TRAIN 15MIN,35097537,CDM,430,RC,97537,HCPCS,OUTPATIENT,,,85.00,34.00,GO,22.82,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,22.82,72.25,
WHEELCHAIR MANAGEMENT/PROPUL TRAIN 15MIN,35097542,CDM,430,RC,97542,HCPCS,OUTPATIENT,,,74.00,29.60,GO,23.08,80,,,fee schedule,80% of Aetna fee schedule,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,39.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.08,62.9,
HOT PACK COLD PACK,36000206,CDM,420,RC,97010,HCPCS,OUTPATIENT,,,82.00,32.80,GP,4.57,80,,,fee schedule,80% of Aetna fee schedule,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.68,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,4.57,69.7,
***DIATHERMY,36000214,CDM,420,RC,97024,HCPCS,OUTPATIENT,,,20.00,8.00,GP,5.08,80,,,fee schedule,80% of Aetna fee schedule,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,8.9,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,5.08,17,
***MYOFASCIAL RELEASE/PER 15 MIN,36000220,CDM,420,RC,97032,HCPCS,OUTPATIENT,,,79.00,31.60,GP,14.33,80,,,fee schedule,80% of Aetna fee schedule,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,14.33,67.15,
UNATTENDED E STIMULATION/NON WOUND CARE,36000222,CDM,420,RC,G0283,HCPCS,OUTPATIENT,,,37.00,14.80,GP,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
ATTENDED E STIMULATION,36000223,CDM,420,RC,97032,HCPCS,OUTPATIENT,,,48.00,19.20,GP,14.33,80,,,fee schedule,80% of Aetna fee schedule,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,18.34,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,14.33,40.8,
MECHANICAL TRACTION,36000248,CDM,420,RC,97012,HCPCS,OUTPATIENT,,,45.00,18.00,GP,12.29,80,,,fee schedule,80% of Aetna fee schedule,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.93,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,12.29,38.25,
WORK HARDENING/CONDITIONING INIT 2HR,36000250,CDM,420,RC,97545,HCPCS,OUTPATIENT,,,266.00,106.40,GP,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.6,60,,127.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,186.2,70,,148.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,32,,68.1,percent of total billed charges,32% of total billed charges,85.12,226.1,
MASSAGE PER 15 MIN,36000263,CDM,420,RC,97124,HCPCS,OUTPATIENT,,,66.00,26.40,GO,19.6,80,,,fee schedule,80% of Aetna fee schedule,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,60,,31.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.88,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,46.2,70,,36.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,21.12,32,,16.9,percent of total billed charges,32% of total billed charges,19.6,56.1,
MOBILITY CURRENT STATUS CH,36000264,CDM,420,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY GOAL STATUS CH,36000265,CDM,420,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY D/C STATUS CH,36000266,CDM,420,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS CURRENT STATUS CH,36000267,CDM,420,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS GOAL STATUS CH,36000268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS D/C STATUS CH,36000269,CDM,420,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY CURRENT STATUS CH,36000270,CDM,420,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY GOAL STATUS CH,36000271,CDM,420,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY D/C STATUS CH,36000272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE CURRENT STATUS CH,36000273,CDM,420,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE GOAL STATUS CH,36000274,CDM,420,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE D/C STATUS CH,36000275,CDM,420,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY CURRENT CH,36000276,CDM,420,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY GOAL CH,36000277,CDM,420,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY D/C CH,36000278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
ELECT STIM (UNATTENDED) 1 OR > NOT WC,36000283,CDM,420,RC,G0283,HCPCS,OUTPATIENT,,,30.00,12.00,CQ,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,60,,14.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,15.3,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,21,70,,16.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,32,,7.68,percent of total billed charges,32% of total billed charges,9.6,25.5,
PARAFFIN,36000297,CDM,420,RC,97018,HCPCS,OUTPATIENT,,,21.00,8.40,,7.89,80,,,fee schedule,80% of Aetna fee schedule,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,7.28,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
ULTRASOUND PER 15 MIN,36000321,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,38.00,15.20,,9.66,80,,,fee schedule,80% of Aetna fee schedule,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,9.66,32.3,
WHIRLPOOL,36000339,CDM,420,RC,97022,HCPCS,OUTPATIENT,,,45.00,18.00,GP,17,80,,,fee schedule,80% of Aetna fee schedule,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
***WHIRLPOOL OPEN WOUND,36000347,CDM,420,RC,97022,HCPCS,OUTPATIENT,,,45.00,18.00,GP,17,80,,,fee schedule,80% of Aetna fee schedule,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,21.38,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
MANUAL THERAPY/PER 15 MIN,36000420,CDM,420,RC,97140,HCPCS,OUTPATIENT,,,89.00,35.60,,22.54,80,,,fee schedule,80% of Aetna fee schedule,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,22.54,75.65,
NEUROMUSCULAR RE-EDUCATION/PER 15 MIN,36000445,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,85.00,34.00,GP,25.12,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,25.12,72.25,
GAIT TRAINING PER 15 MINUTES,36000453,CDM,420,RC,97116,HCPCS,OUTPATIENT,,,74.00,29.60,GP,21.22,80,,,fee schedule,80% of Aetna fee schedule,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,21.22,62.9,
***DEBRIDEMENT PER 15 MIN,36000636,CDM,420,RC,97597,HCPCS,OUTPATIENT,,,115.00,46.00,GP,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69,60,,55.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,126.6,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,80.5,70,,64.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,32,,29.44,percent of total billed charges,32% of total billed charges,36.8,126.6,
***DRESSING CHANGE PER 15 MIN,36000644,CDM,420,RC,97139,HCPCS,OUTPATIENT,,,51.00,20.40,GP,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
PT RE EVAL,36000719,CDM,420,RC,97164,HCPCS,OUTPATIENT,,,118.00,47.20,,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.8,60,,56.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,86.25,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,82.6,70,,66.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,32,,30.21,percent of total billed charges,32% of total billed charges,37.76,100.3,
THERAPUTIC EXERCISE PER 15 MIN,36000768,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,85.00,34.00,GP,24.1,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,24.1,72.25,
MED-X LUMBAR TEST,36000775,CDM,420,RC,97750,HCPCS,OUTPATIENT,,,85.00,34.00,GP,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,72.25,
***THERAPUTIC EXERCISE 16-30 MIN,36000776,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,90.00,36.00,GP,24.1,80,,,fee schedule,80% of Aetna fee schedule,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,24.1,76.5,
MED-X LUMBAR EXERCISE,36000780,CDM,420,RC,97530,HCPCS,OUTPATIENT,,,86.00,34.40,GP,26.13,80,,,fee schedule,80% of Aetna fee schedule,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,60,,41.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,60.2,70,,48.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,27.52,32,,22.02,percent of total billed charges,32% of total billed charges,26.13,73.1,
***THERAPUTIC EXERCISE 31-45 MIN,36000784,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,90.00,36.00,GP,24.1,80,,,fee schedule,80% of Aetna fee schedule,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,24.1,76.5,
***THERAPUTIC EXERCISE 46-60 MIN,36000792,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,90.00,36.00,GP,24.1,80,,,fee schedule,80% of Aetna fee schedule,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,24.1,76.5,
PT EVAL LI,36000800,CDM,420,RC,97161,HCPCS,OUTPATIENT,,,219.00,87.60,GP,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.4,60,,105.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,125.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,186.15,
PT EVAL LII,36000801,CDM,420,RC,97162,HCPCS,OUTPATIENT,,,219.00,87.60,GP,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.4,60,,105.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,125.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,186.15,
PT EVAL LIII,36000802,CDM,420,RC,97163,HCPCS,OUTPATIENT,,,219.00,87.60,GP,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.4,60,,105.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,125.79,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,153.3,70,,122.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,32,,56.06,percent of total billed charges,32% of total billed charges,70.08,186.15,
***GAIT TRAINING 16-30 MIN,36000842,CDM,420,RC,97116,HCPCS,OUTPATIENT,,,74.00,29.60,GP,21.22,80,,,fee schedule,80% of Aetna fee schedule,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,60,,35.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,51.8,70,,41.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,23.68,32,,18.94,percent of total billed charges,32% of total billed charges,21.22,62.9,
***T E N S INSTR WITH 1 RECHECK,36000859,CDM,420,RC,97139,HCPCS,OUTPATIENT,,,51.00,20.40,GP,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
***JOBST MEASUREMENTS 15 MIN,36000891,CDM,420,RC,97139,HCPCS,OUTPATIENT,,,51.00,20.40,GP,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
MOBILITY D/C STATUS CI,36001126,CDM,420,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY CURRENT STATUS CI,36001264,CDM,420,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY GOAL STATUS CI,36001265,CDM,420,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS CURRENT STATUS CI,36001267,CDM,420,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS GOAL STATUS CI,36001268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS D/C STATUS CI,36001269,CDM,420,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY CURRENT STATUS CI,36001270,CDM,420,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY GOAL STATUS CI,36001271,CDM,420,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY D/C STATUS CI,36001272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE CURRENT STATUS CI,36001273,CDM,420,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE GOAL STATUS CI,36001274,CDM,420,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE D/C STATUS CI,36001275,CDM,420,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY CURRENT CI,36001276,CDM,420,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY GOAL CI,36001277,CDM,420,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GPCI,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY D/C CI,36001278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GPCH,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
***PHONOPHORESIS,36002012,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,36.00,14.40,GP,9.66,80,,,fee schedule,80% of Aetna fee schedule,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,9.66,30.6,
SELF CARE/HOME MGMT PROG PER 15 MIN,36002046,CDM,420,RC,97535,HCPCS,OUTPATIENT,,,89.00,35.60,GP,26.14,80,,,fee schedule,80% of Aetna fee schedule,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,60,,42.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,62.3,70,,49.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,28.48,32,,22.78,percent of total billed charges,32% of total billed charges,26.14,75.65,
IONTOPHORESIS,36002095,CDM,420,RC,97033,HCPCS,OUTPATIENT,,,63.00,25.20,GP,23.54,80,,,fee schedule,80% of Aetna fee schedule,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
MOBILITY CURRENT STATUS CJ,36002264,CDM,420,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY GOAL STATUS CJ,36002265,CDM,420,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY D/C STATUS CJ,36002266,CDM,420,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS CURRENT STATUS CJ,36002267,CDM,420,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS GOAL STATUS CJ,36002268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS D/C STATUS CJ,36002269,CDM,420,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY CURRENT STATUS CJ,36002270,CDM,420,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY GOAL STATUS CJ,36002271,CDM,420,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY D/C STATUS CJ,36002272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE CURRENT STATUS CJ,36002273,CDM,420,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE GOAL STATUS CJ,36002274,CDM,420,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE D/C STATUS CJ,36002275,CDM,420,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY CURRENT CJ,36002276,CDM,420,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY GOAL CJ,36002277,CDM,420,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY D/C CJ,36002278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GPCJ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY CURRENT STATUS CK,36003264,CDM,420,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY GOAL STATUS CK,36003265,CDM,420,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY D/C STATUS CK,36003266,CDM,420,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS CURRENT STATUS CK,36003267,CDM,420,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS GOAL STATUS CK,36003268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS D/C STATUS CK,36003269,CDM,420,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY CURRENT STATUS CK,36003270,CDM,420,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY GOAL STATUS CK,36003271,CDM,420,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY D/C STATUS CK,36003272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE CURRENT STATUS CK,36003273,CDM,420,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE GOAL STATUS CK,36003274,CDM,420,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE D/C STATUS CK,36003275,CDM,420,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY CURRENT CK,36003276,CDM,420,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY GOAL CK,36003277,CDM,420,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY D/C CK,36003278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GPCK,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY CURRENT STATUS CL,36004264,CDM,420,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY GOAL STATUS CL,36004265,CDM,420,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY D/C STATUS CL,36004266,CDM,420,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS CURRENT STATUS CL,36004267,CDM,420,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS GOAL STATUS CL,36004268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS D/C STATUS CL,36004269,CDM,420,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY CURRENT STATUS CL,36004270,CDM,420,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY GOAL STATUS CL,36004271,CDM,420,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY D/C STATUS CL,36004272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE CURRENT STATUS CL,36004273,CDM,420,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE GOAL STATUS CL,36004274,CDM,420,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE D/C STATUS CL,36004275,CDM,420,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY CURRENT CL,36004276,CDM,420,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY GOAL CL,36004277,CDM,420,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY D/C CL,36004278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GPCL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY CURRENT STATUS CM,36005264,CDM,420,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY GOAL STATUS CM,36005265,CDM,420,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY D/C STATUS CM,36005266,CDM,420,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS CURRENT STATUS CM,36005267,CDM,420,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS GOAL STATUS CM,36005268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS D/C STATUS CM,36005269,CDM,420,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY CURRENT STATUS CM,36005270,CDM,420,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY GOAL STATUS CM,36005271,CDM,420,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY D/C STATUS CM,36005272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE CURRENT STATUS CM,36005273,CDM,420,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE GOAL STATUS CM,36005274,CDM,420,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE D/C STATUS CM,36005275,CDM,420,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY CURRENT CM,36005276,CDM,420,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY GOAL CM,36005277,CDM,420,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY D/C CM,36005278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY CURRENT STATUS CN,36006264,CDM,420,RC,G8978,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY GOAL STATUS CN,36006265,CDM,420,RC,G8979,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
MOBILITY D/C STATUS CN,36006266,CDM,420,RC,G8980,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS CURRENT STATUS CN,36006267,CDM,420,RC,G8981,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS GOAL STATUS CN,36006268,CDM,420,RC,G8982,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
BODY POS D/C STATUS CN,36006269,CDM,420,RC,G8983,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY CURRENT STATUS CN,36006270,CDM,420,RC,G8984,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY GOAL STATUS CN,36006271,CDM,420,RC,G8985,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
CARRY D/C STATUS CN,36006272,CDM,420,RC,G8986,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE CURRENT STATUS CN,36006273,CDM,420,RC,G8987,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE GOAL STATUS CN,36006274,CDM,420,RC,G8988,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
SELF CARE D/C STATUS CN,36006275,CDM,420,RC,G8989,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY CURRENT CN,36006276,CDM,420,RC,G8990,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY GOAL CM,36006277,CDM,420,RC,G8991,HCPCS,OUTPATIENT,,,0.01,0.00,GPCM,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
OTHER PRIMARY D/C CN,36006278,CDM,420,RC,G8992,HCPCS,OUTPATIENT,,,0.01,0.00,GPCN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,60,,0.01,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,85,,0.01,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,70,,0.01,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,32,,0.01,percent of total billed charges,32% of total billed charges,0.01,0.01,
APP OF MODALITY 1 OR > AREAS; IONTOPH EA,36097033,CDM,420,RC,97033,HCPCS,OUTPATIENT,,,49.00,19.60,CQ,23.54,80,,,fee schedule,80% of Aetna fee schedule,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.4,60,,23.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,24.45,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,34.3,70,,27.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,32,,12.54,percent of total billed charges,32% of total billed charges,15.68,41.65,
"AP OF MODALITY 1 OR > AREA, US 15MIN",36097035,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,36.00,14.40,CQ,9.66,80,,,fee schedule,80% of Aetna fee schedule,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,17.83,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,9.66,30.6,
"THERA PROCED 1 OR > AREAS, TX EX, EA 15M",36097110,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,73.00,29.20,CQ,24.1,80,,,fee schedule,80% of Aetna fee schedule,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,62.05,
"THERA PROCED, 1 OR > AREAS; THERA EX EA",36097112,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,83.00,33.20,CQ,25.12,80,,,fee schedule,80% of Aetna fee schedule,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.8,60,,39.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,42.76,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,58.1,70,,46.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,26.56,32,,21.25,percent of total billed charges,32% of total billed charges,25.12,70.55,
"THERA PROCED, 1 OR > AREAS; GAIT TRNG 15",36097116,CDM,420,RC,97116,HCPCS,OUTPATIENT,,,73.00,29.20,CQ,21.22,80,,,fee schedule,80% of Aetna fee schedule,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,60,,35.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,36.95,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,51.1,70,,40.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,23.36,32,,18.69,percent of total billed charges,32% of total billed charges,21.22,62.05,
MANUAL TX TECH 1 OR > REGIONS EA 15 MIN,36097140,CDM,420,RC,97140,HCPCS,OUTPATIENT,,,67.00,26.80,CQ,22.54,80,,,fee schedule,80% of Aetna fee schedule,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,34.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
THERAPEUTIC ACTIVITIES PER 15 MIN,36097530,CDM,420,RC,97530,HCPCS,OUTPATIENT,,,85.00,34.00,GO,26.13,80,,,fee schedule,80% of Aetna fee schedule,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51,60,,40.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,46.26,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,59.5,70,,47.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,27.2,32,,21.76,percent of total billed charges,32% of total billed charges,26.13,72.25,
SELF-CARE MANGT TRNG; DIRECT 1-1 CONT; E,36097535,CDM,420,RC,97535,HCPCS,OUTPATIENT,,,81.00,32.40,CQ,26.14,80,,,fee schedule,80% of Aetna fee schedule,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,41.01,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
WORK HARDENING/CONDITIONING ea add'l hr,36097546,CDM,420,RC,97545,HCPCS,OUTPATIENT,,,134.00,53.60,GP,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.4,60,,64.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,93.8,70,,75.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,32,,34.3,percent of total billed charges,32% of total billed charges,42.88,113.9,
HOSPITAL CONVIENCE NO CHARGE,38000001,CDM,540,RC,,,OUTPATIENT,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,350,350,
CONVALESENT TRANSPORT,38000002,CDM,540,RC,A0428,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,350,
"BLS NON-EMERGENCY NON-COVERE,PT INFORMED",38000006,CDM,540,RC,A0428,HCPCS,OUTPATIENT,,,216.00,86.40,,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,60,,103.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,151.2,70,,120.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,69.12,32,,55.3,percent of total billed charges,32% of total billed charges,69.12,350,
"ALS NON-EMERGENCY NON-COVERE,PT INFORME",38000008,CDM,540,RC,A0426,HCPCS,OUTPATIENT,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,350,350,
BLS  EMERGENCY,38002032,CDM,540,RC,A0428,HCPCS,OUTPATIENT,,,599.00,239.60,QN,,,,,other ,not seperately reimbursable,191.68,32,,153.34,percent of total billed charges,32% of total billed charges,191.68,32,,153.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.4,60,,287.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.68,32,,153.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.68,32,,153.34,percent of total billed charges,32% of total billed charges,509.15,85,,407.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.68,32,,153.34,percent of total billed charges,32% of total billed charges,191.68,32,,153.34,percent of total billed charges,32% of total billed charges,419.3,70,,335.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,191.68,32,,153.34,percent of total billed charges,32% of total billed charges,191.68,509.15,
BLS EMERGENCY,38002059,CDM,540,RC,A0429,HCPCS,OUTPATIENT,,,957.00,382.80,QN,,,,,other ,not seperately reimbursable,306.24,32,,244.99,percent of total billed charges,32% of total billed charges,306.24,32,,244.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.2,60,,459.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306.24,32,,244.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306.24,32,,244.99,percent of total billed charges,32% of total billed charges,813.45,85,,650.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306.24,32,,244.99,percent of total billed charges,32% of total billed charges,306.24,32,,244.99,percent of total billed charges,32% of total billed charges,669.9,70,,535.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,306.24,32,,244.99,percent of total billed charges,32% of total billed charges,306.24,813.45,
ALS EMERGENCY-LEVEL 1,38002349,CDM,540,RC,A0427,HCPCS,OUTPATIENT,,,1136.00,454.40,QN,,,,,other ,not seperately reimbursable,363.52,32,,290.82,percent of total billed charges,32% of total billed charges,363.52,32,,290.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,60,,545.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363.52,32,,290.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363.52,32,,290.82,percent of total billed charges,32% of total billed charges,965.6,85,,772.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363.52,32,,290.82,percent of total billed charges,32% of total billed charges,363.52,32,,290.82,percent of total billed charges,32% of total billed charges,795.2,70,,636.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,363.52,32,,290.82,percent of total billed charges,32% of total billed charges,350,965.6,
ALS  non EMERGENCY,38002351,CDM,540,RC,A0426,HCPCS,OUTPATIENT,,,717.00,286.80,QN,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.2,60,,344.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,609.45,85,,487.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,501.9,70,,401.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,229.44,609.45,
ALS NON EMERGENCY,38002356,CDM,540,RC,A0426,HCPCS,OUTPATIENT,,,717.00,286.80,QN,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430.2,60,,344.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,609.45,85,,487.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,501.9,70,,401.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,229.44,32,,183.55,percent of total billed charges,32% of total billed charges,229.44,609.45,
ALS EMERGENCY LEVEL 2,38002358,CDM,540,RC,A0433,HCPCS,OUTPATIENT,,,1643.00,657.20,QN,,,,,other ,not seperately reimbursable,525.76,32,,420.61,percent of total billed charges,32% of total billed charges,525.76,32,,420.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,985.8,60,,788.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,525.76,32,,420.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,525.76,32,,420.61,percent of total billed charges,32% of total billed charges,1396.55,85,,1117.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,525.76,32,,420.61,percent of total billed charges,32% of total billed charges,525.76,32,,420.61,percent of total billed charges,32% of total billed charges,1150.1,70,,920.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,525.76,32,,420.61,percent of total billed charges,32% of total billed charges,350,1396.55,
ALS BLS WAITING PER 1/2 HR,38002521,CDM,540,RC,A0420,HCPCS,OUTPATIENT,,,157.00,62.80,QN,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,350,
ALS PER MILE,38002589,CDM,540,RC,A0425,HCPCS,OUTPATIENT,,,21.00,8.40,QN,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,350,
BLS PER MILE,38002645,CDM,540,RC,A0425,HCPCS,OUTPATIENT,,,21.00,8.40,QN,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,350,
CANNULA O2,38002893,CDM,541,RC,A4615,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
SUCTION TUBING,38003164,CDM,541,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
TONSIL SUCTION,38003216,CDM,541,RC,,,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
SUCTION LINER,38003254,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
VENTILATOR/P HR,38003258,CDM,541,RC,,,OUTPATIENT,,,80.00,32.00,,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,60,,38.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,56,70,,44.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,32,,20.48,percent of total billed charges,32% of total billed charges,25.6,68,
MASK NON REBREATHER,38003289,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
AMBU BAG,38003291,CDM,541,RC,,,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
ORAL AIRWAY,38003367,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
SUCTION CATHETER,38003451,CDM,541,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
OXYGEN PER HR,38003467,CDM,544,RC,A0422,HCPCS,OUTPATIENT,,,50.00,20.00,,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,60,,24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,35,70,,28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,32,,12.8,percent of total billed charges,32% of total billed charges,16,42.5,
STYLETTE,38003468,CDM,541,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
INTUBATION PROC,38003489,CDM,541,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
MASK NEBULIZER,38003587,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
NG TUBE & 60CC,38003597,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
PULSE OXIMETRY,38003624,CDM,544,RC,94760,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,57.96,272,,,fee schedule,272% of BCBS fee schedule,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,3.05,125,,,fee schedule,125% of CMS fee schedule,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,3.05,57.96,
NASAL AIRWAY,38003697,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
ENDO TUBE,38003786,CDM,541,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ENDO TUBE HOLDER,38003891,CDM,541,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
MASK O2,38003961,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
CARDIOVERSION,38004316,CDM,541,RC,,,OUTPATIENT,,,157.00,62.80,,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.2,60,,75.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,109.9,70,,87.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,32,,40.19,percent of total billed charges,32% of total billed charges,50.24,133.45,
PACER PADS,38004921,CDM,541,RC,,,OUTPATIENT,,,111.00,44.40,,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.6,60,,53.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,77.7,70,,62.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,32,,28.42,percent of total billed charges,32% of total billed charges,35.52,94.35,
DEFIB PADS,38004981,CDM,541,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,81.6,
FLUIDS 500ML,38005143,CDM,547,RC,,,OUTPATIENT,,,96.00,38.40,,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,60,,46.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,67.2,70,,53.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,30.72,32,,24.58,percent of total billed charges,32% of total billed charges,30.72,350,
FLUIDS 1000ML,38005214,CDM,547,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,350,
IV SET UP,38005216,CDM,541,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
HIGH FLOW TRAUMA TUBING,38005412,CDM,541,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
IO NEEDLE,38005421,CDM,541,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
PUMP & TUBING/PK,38005489,CDM,541,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
D50,38006012,CDM,547,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,350,
EPI 1: 1000,38006015,CDM,547,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,350,
ASPIRIN,38006032,CDM,547,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,350,
ALBUTEROL/VIAL,38006048,CDM,547,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,350,
DEMEROL,38006123,CDM,547,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,350,
ACTIVATED CHARCOAL,38006124,CDM,547,RC,,,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,350,
DIPHENHYDRAMINE,38006134,CDM,547,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,350,
EPI HIGH DOSE/EA,38006158,CDM,547,RC,,,OUTPATIENT,,,36.00,14.40,,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,60,,17.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,25.2,70,,20.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,11.52,32,,9.22,percent of total billed charges,32% of total billed charges,11.52,350,
DOPAMINE DRIP,38006214,CDM,547,RC,,,OUTPATIENT,,,140.00,56.00,,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,60,,67.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,98,70,,78.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,44.8,32,,35.84,percent of total billed charges,32% of total billed charges,44.8,350,
ADENOCARD/VIAL,38006218,CDM,547,RC,,,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,350,
EPI 1: 10000,38006219,CDM,547,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,350,
IPECAC/PER 15ML,38006243,CDM,547,RC,,,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,350,
ISUPREL DRIP,38006312,CDM,547,RC,,,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,350,
LASIX,38006316,CDM,547,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,350,
NITRO SPRAY PER PATIENT,38006319,CDM,547,RC,,,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,350,
SODIUM BICARB,38006371,CDM,547,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,350,
ROMAZICON VIAL,38006381,CDM,547,RC,,,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,350,
THIAMINE,38006382,CDM,547,RC,,,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,350,
BRETYLOL,38006452,CDM,547,RC,,,OUTPATIENT,,,183.00,73.20,,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.8,60,,87.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,128.1,70,,102.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,350,
ATROPINE,38006458,CDM,547,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,350,
INSTAGLUCOSE TUBE,38006512,CDM,547,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,350,
NARCAN,38006521,CDM,547,RC,,,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,350,
VALIUM,38006531,CDM,547,RC,,,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,350,
DILANTIN,38006541,CDM,547,RC,,,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,350,
MORPHINE,38006543,CDM,547,RC,,,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,350,
LIDOCAINE 2GM DRIP,38006583,CDM,547,RC,,,OUTPATIENT,,,223.00,89.20,,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.8,60,,107.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,156.1,70,,124.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,350,
LIDOCAINE 100MG,38006589,CDM,547,RC,,,OUTPATIENT,,,223.00,89.20,,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.8,60,,107.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,156.1,70,,124.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,71.36,32,,57.09,percent of total billed charges,32% of total billed charges,71.36,350,
PHENEGRAN 25MG,38006610,CDM,547,RC,,,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,350,
PROCAINAMIDE,38006912,CDM,547,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,350,
CERVICAL COLLAR,38007061,CDM,541,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
HEAD BED,38007164,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
KED,38007215,CDM,541,RC,,,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
BURN SHEET,38007216,CDM,541,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
MULTI DRESSING TRAUMA,38007283,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
TRACTION SPLINTING,38007512,CDM,541,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
TRIANGULAR BANDAGE,38007513,CDM,541,RC,,,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
SPINAL IMMOB PROCEDURE,38007612,CDM,541,RC,,,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
VASELINE GAUGE,38007812,CDM,541,RC,,,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ACE BANDAGE,38007891,CDM,541,RC,,,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
OB KIT,38008521,CDM,541,RC,,,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
BODY BAG,38008712,CDM,541,RC,,,OUTPATIENT,,,63.00,25.20,,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,60,,30.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,44.1,70,,35.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,32,,16.13,percent of total billed charges,32% of total billed charges,20.16,53.55,
ICE PAK,38008721,CDM,541,RC,,,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BLS  EMERGENCY,38802032,CDM,540,RC,A0428,HCPCS,OUTPATIENT,,,549.00,219.60,QN,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.4,60,,263.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,384.3,70,,307.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,175.68,32,,140.54,percent of total billed charges,32% of total billed charges,175.68,466.65,
ALS EMERGENCY-LEVEL 1,38802349,CDM,540,RC,A0427,HCPCS,OUTPATIENT,,,864.00,345.60,QN,,,,,other ,not seperately reimbursable,276.48,32,,221.18,percent of total billed charges,32% of total billed charges,276.48,32,,221.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,518.4,60,,414.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,276.48,32,,221.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,276.48,32,,221.18,percent of total billed charges,32% of total billed charges,734.4,85,,587.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,276.48,32,,221.18,percent of total billed charges,32% of total billed charges,276.48,32,,221.18,percent of total billed charges,32% of total billed charges,604.8,70,,483.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,276.48,32,,221.18,percent of total billed charges,32% of total billed charges,276.48,734.4,
ALS NON EMERGENCY,38802356,CDM,540,RC,A0426,HCPCS,OUTPATIENT,,,648.00,259.20,QN,,,,,other ,not seperately reimbursable,207.36,32,,165.89,percent of total billed charges,32% of total billed charges,207.36,32,,165.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.8,60,,311.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.36,32,,165.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.36,32,,165.89,percent of total billed charges,32% of total billed charges,550.8,85,,440.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.36,32,,165.89,percent of total billed charges,32% of total billed charges,207.36,32,,165.89,percent of total billed charges,32% of total billed charges,453.6,70,,362.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,207.36,32,,165.89,percent of total billed charges,32% of total billed charges,207.36,550.8,
PER MILE,38802589,CDM,540,RC,A0425,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,350,100,,,case rate,pays based on per visit rate,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,350,
BUR OVAL #277-10-62,61000194,CDM,272,RC,,,OUTPATIENT,,,91.00,36.40,,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.6,60,,43.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,63.7,70,,50.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,32,,23.3,percent of total billed charges,32% of total billed charges,29.12,77.35,
REGULAR DIET,62000000,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
=> FOOD/BEVERAGE PREFERENCE <=,62000001,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
=> SNACK ORDER <=,62000002,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
=> SPECIAL INSTRUCTIONS <=,62000003,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
=> PARENT.GUEST TRAY <=,62000004,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
=> ISOLATION TRAY <=,62000005,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
=> NUTRITIONAL ASSESSMENT <=,62000006,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
=> DIETARY CONSULT <=,62000007,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
NPO,62000008,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
LOW SALT,62000009,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
1800 ADA,62000010,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
ADA CLEAR,62000011,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
CLEAR LIQUIDS,62000012,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
ADA FULL LIQUIDS,62000013,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
FULL LIQUIDS,62000014,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
TUBE FEEDING,62000015,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
BLAND,62000016,CDM,160,RC,,,INPATIENT,,,,,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,2711,
ENSURE PLUS - 8 OZ BTL,62000017,CDM,160,RC,,,INPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2711,100,,,per diem,pays based on per day rate,2711,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,2711,100,,,per diem ,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2711,100,,,per diem ,pays based on per day rate,5.4,2711,
VISIPAQUE 270 - 100 ML BOTTLE,22804032,CDM,255,RC,Q9965,HCPCS,OUTPATIENT,,,200.00,80.00,,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,60,,96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,140,70,,112,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,32,,51.2,percent of total billed charges,32% of total billed charges,64,170,
TRUSOPT 2% 10ML,31006118,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,171.00,68.40,,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.6,60,,82.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,119.7,70,,95.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,32,,43.78,percent of total billed charges,32% of total billed charges,54.72,145.35,
HEPATITIS B IMMUNE GLOB:5ml,31009006,CDM,250,RC,90371,HCPCS,OUTPATIENT,,,1177.50,471.00,,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706.5,60,,565.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,1000.88,85,,800.7,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,824.25,70,,659.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,32,,301.44,percent of total billed charges,32% of total billed charges,376.8,1000.88,
HIV PEP BASIC KIT:BASIC KIT,31009015,CDM,250,RC,J1562,HCPCS,OUTPATIENT,,,384.00,153.60,,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,60,,184.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,326.4,85,,261.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,268.8,70,,215.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,32,,98.3,percent of total billed charges,32% of total billed charges,122.88,326.4,
HIV PEP EXPANDED KIT:EXPANDED,31009016,CDM,250,RC,J1562,HCPCS,OUTPATIENT,,,714.00,285.60,,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.4,60,,342.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,606.9,85,,485.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,499.8,70,,399.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,32,,182.78,percent of total billed charges,32% of total billed charges,228.48,606.9,
COGENTIN INJ 1 MG /ML 2 ML EQU,31022042,CDM,250,RC,J0515,HCPCS,OUTPATIENT,,,108.00,43.20,,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,60,,51.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,75.6,70,,60.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,32,,27.65,percent of total billed charges,32% of total billed charges,34.56,91.8,
ARANESP 40MCG/ML:40MG,31031008,CDM,636,RC,J0882,HCPCS,OUTPATIENT,,,280.00,112.00,,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,60,,134.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,196,70,,156.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,32,,71.68,percent of total billed charges,32% of total billed charges,89.6,238,
BREVIBLOC AMP: 2500MG/10ML,31043051,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,389.00,155.60,,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.4,60,,186.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,330.65,85,,264.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,272.3,70,,217.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,32,,99.58,percent of total billed charges,32% of total billed charges,124.48,330.65,
EFFEXOR XR 37.5MG:37.5MG,31054056,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
EFFEXOR-XR 150MG:150MG,31054057,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
VENLAFAXINE TAB 50MG:50MG,31054060,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
COMPAZINE TAB:10 MG,31055008,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
COCAINE TOPICAL 4% 4 ML,31055038,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
hydrOXYzine SYRUP 10 MG/5 ML,31055063,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIAZEPAM TAB 2MG:2MG,31055078,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
COMPAZINE SUPP: 2.5MG,31055094,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
COMPAZINE SUPP: 5MG,31055095,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
COMPAZINE SUPP: 25MG,31055096,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
ALPRAZolam 0.25 MG TABLET,31055137,CDM,250,RC,A9270,HCPCS,OUTPATIENT,,,9.00,3.60,GY,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ALPRAZolam 1 MG TABLET,31055139,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
clonazePAM 0.5 MG TABLET,31055151,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CLONAZEPAM 1MG TAB,31055152,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
AMMONIA AROMATIC CAP:0.4ML,31056009,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ZOLPIDEM 5 MG TABLET,31057011,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
ZOLPIDEM 10 MG TABLET,31057012,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
MELATONIN 3 MG TABLET,31057013,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,4.00,1.60,,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,60,,1.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,2.8,70,,2.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,32,,1.02,percent of total billed charges,32% of total billed charges,1.28,3.4,
FIORINAL CAP NO.3,31058002,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DEMEROL-PCA,31058040,CDM,259,RC,99088,HCPCS,OUTPATIENT,,,125.00,50.00,,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75,60,,60,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,87.5,70,,70,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,40,32,,32,percent of total billed charges,32% of total billed charges,40,32,,32,percent of total billed charges,32% of total billed charges,40,106.25,
BREVITAL INJ:500MG,31058067,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
BELLADONNA/OPIUM RS 30-16MG,31058069,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
B & O SUPP:16 A,31058070,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
CHLORAL HYDRATE SYRUP:10ML,31058082,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ALFENTA AMP : 2 ML,31058084,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,78.00,31.20,,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,60,,37.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,54.6,70,,43.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,32,,19.97,percent of total billed charges,32% of total billed charges,24.96,66.3,
HYDROMORPHONE 2MG TAB-bad #-USE 31058151,31058131,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
CHLORAL HYDRATE CAP: 500MG,31058141,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CHLORAL HYDRATE:650MG RS,31058145,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
HYDROMORPHONE TAB: 4MG,31058149,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
HYDROmorphone 2 MG TABLET,31058151,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
fentaNYL 25 MCG/HOUR PATCH,31058171,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
fentaNYL 50 MCG/HOUR PATCH,31058189,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,20.79,8.32,,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.47,60,,9.98,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,17.67,85,,14.14,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,14.55,70,,11.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,32,,5.32,percent of total billed charges,32% of total billed charges,6.65,17.67,
fentaNYL 100 MCG/HOUR PATCH,31058190,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,122.00,48.80,,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,60,,58.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,85.4,70,,68.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,32,,31.23,percent of total billed charges,32% of total billed charges,39.04,103.7,
fentaNYL 75 MCG/HOUR PATCH,31058191,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
DECADRON OPTH OINT:1/8OZ EQ,31061004,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
CORTISPORIN OPTH OINT: 1/8 OZ,31061007,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,60.00,24.00,,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,60,,28.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,42,70,,33.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,32,,15.36,percent of total billed charges,32% of total billed charges,19.2,51,
CYCLOGYL 1% OPTH DROP: 15ML,31061012,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
CYCLOPENTOLATE 1% OPTH DOSE,31061021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
BETOPTIC 0.25%:2.5MLS,31061023,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
BSS:15ML,31061025,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
BSS:500 ML,31061026,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,109.00,43.60,,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,60,,52.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,76.3,70,,61.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,32,,27.9,percent of total billed charges,32% of total billed charges,34.88,92.65,
CHLOROMYCETIN OPH OINT:1/8 OZ,31061027,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,90.00,36.00,,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,60,,43.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,63,70,,50.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,32,,23.04,percent of total billed charges,32% of total billed charges,28.8,76.5,
SULFACETAMIDE OPHTH SOLN 10% 15ML:15ML,31061029,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
BLEPH-10 OPTH SOL: 5ML,31061030,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,54.00,21.60,,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,60,,25.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,37.8,70,,30.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,32,,13.82,percent of total billed charges,32% of total billed charges,17.28,45.9,
BLEPH-10 OPTH OINT: 3.5GM,31061031,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
SPIRIVA HANDIHALER 18 MCG CAPULES,31061036,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
ATROVENT HFA MDI:MDI,31061039,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,513.00,205.20,,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.8,60,,246.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,359.1,70,,287.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,32,,131.33,percent of total billed charges,32% of total billed charges,164.16,436.05,
ALPHAGAN 0.2% OPHTH SOLN:5ML,31061054,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
ALPHAGAN-P 0.15% OPHTH SOL 5ML:5ML,31061055,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,119.00,47.60,,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.4,60,,57.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,83.3,70,,66.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,32,,30.46,percent of total billed charges,32% of total billed charges,38.08,101.15,
REFRESH CELLUVISC EYE GEL - 0.4 ML,31061064,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
ATROPINE 1% OPHTHALMIC DROPS - 5ML BTL,31061071,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
PHENYLEPHRINE 2.5% OPHTH SOLN 3 ML,31061080,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
TROPICAMIDE 1% OPHTH SOLN 2ML,31061082,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
COSOPT OPHTH SOLN 10ML,31061084,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,313.00,125.20,,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.8,60,,150.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,219.1,70,,175.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,32,,80.13,percent of total billed charges,32% of total billed charges,100.16,266.05,
NEOMY/POLY B/DEXAMETH OPHTH OINT 3.5GM,31061086,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,46.00,18.40,,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,60,,22.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,32.2,70,,25.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,32,,11.78,percent of total billed charges,32% of total billed charges,14.72,39.1,
PILOCARPINE 4% OPHTH SOLN,31061088,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
CIPROFLOXACIN 0.3% EYE DROPS - 2.5 ML,31061102,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
CHLOROMYCETIN OPH SOL:15ML,31061104,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,105.00,42.00,,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,60,,50.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,73.5,70,,58.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,32,,26.88,percent of total billed charges,32% of total billed charges,33.6,89.25,
CILOXAN OPHTH OINT 4GM:4GM,31061110,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,163.00,65.20,,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,60,,78.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,114.1,70,,91.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,32,,41.73,percent of total billed charges,32% of total billed charges,52.16,138.55,
VIGAMOX OPHTH SOLN:3ML,31061112,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,137.00,54.80,,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.2,60,,65.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,95.9,70,,76.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,32,,35.07,percent of total billed charges,32% of total billed charges,43.84,116.45,
FORT GENT EYE GTT:5ML,31061124,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
FORTIFIED TOBREX OPTH DROPS,31061125,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,177.00,70.80,,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.2,60,,84.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,123.9,70,,99.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,32,,45.31,percent of total billed charges,32% of total billed charges,56.64,150.45,
FORT VANCOMYCIN GTT: 15ML,31061126,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,149.00,59.60,,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.4,60,,71.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,104.3,70,,83.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,32,,38.14,percent of total billed charges,32% of total billed charges,47.68,126.65,
FORT CEFAZOLIN EYE GTT,31061130,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,112.00,44.80,,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,60,,53.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,78.4,70,,62.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,32,,28.67,percent of total billed charges,32% of total billed charges,35.84,95.2,
DECADRON OPTH SOL 0.1%: 5ML,31061133,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,56.00,22.40,,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,60,,26.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,39.2,70,,31.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,32,,14.34,percent of total billed charges,32% of total billed charges,17.92,47.6,
EYE WASH/IRRIGATION - 118 ML BOTTLE,31061159,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
ACULAR LS 0.4% OPHTH SOLN:5ML,31061170,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,183.00,73.20,,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.8,60,,87.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,128.1,70,,102.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,32,,46.85,percent of total billed charges,32% of total billed charges,58.56,155.55,
SULFACETAMIDE/PREDNIS 10%/0.25% 10ML,31061180,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
TIMOLOL 0.5% OPHTH SOLN 10ML,31061184,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
TIMOLOL OCUDOSE 0.5% 0.2ML,31061210,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
AMERICAINE OTIC:BAD# USE 31062003,31062005,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,72.00,28.80,,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,60,,34.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,50.4,70,,40.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,32,,18.43,percent of total billed charges,32% of total billed charges,23.04,61.2,
FML OPTH DROPS: 5ML,31062010,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
COLY MYCIN S OTIC SUSP 5ML EQ,31062020,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
CERUMENEX OTIC:6ML,31062021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
ACETASOL-HC OTIC SOLN:10ML,31062024,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,82.00,32.80,,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,60,,39.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,57.4,70,,45.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,32,,20.99,percent of total billed charges,32% of total billed charges,26.24,69.7,
AFRIN- -USE GENASAL SPRAY,31063008,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
CHLORASEPTIC SPRAY:6OZ,31064006,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
CEPACOL ANESTHETIC LOZ,31064007,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CEPASTAT ANESTHETIC LOZ,31064008,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CYTOTEC TAB:100MCG,31070002,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
AQUEOUS CHARCOAL 25GM-120ML,31070003,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
ACTIVATED CHARCOAL/SORBITOL 50 GM/240 ML,31070011,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
CYANIDE ANTIDOTE KIT,31070015,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,576.00,230.40,,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.6,60,,276.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,489.6,85,,391.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,403.2,70,,322.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,32,,147.46,percent of total billed charges,32% of total billed charges,184.32,489.6,
MISOPROSTOL 200MCG TAB:200MCG,31070019,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FAMOTIDINE 40 MG TABLET,31070023,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,2,40,,1.6,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FAMOTIDINE 20MG/50ML IVPB,31070027,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
FAMOTIDINE 20 MG/2 ML SDV,31070028,CDM,250,RC,S0028,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
FAMOTIDINE 40 MG/4 ML SDV,31070029,CDM,250,RC,S0028,HCPCS,OUTPATIENT,,,14.00,5.60,,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,60,,6.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,9.8,70,,7.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,32,,3.58,percent of total billed charges,32% of total billed charges,4.48,11.9,
CISAPRIDE TABLET: 20MG,31070034,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
FAMOTIDINE 20MG/NS 10ML IV PUSH,31070050,CDM,250,RC,S0028,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ACTIVATED CHARCOAL SUSP 25 GM/120 ML,31070070,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,33.00,13.20,,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,60,,15.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,23.1,70,,18.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,32,,8.45,percent of total billed charges,32% of total billed charges,10.56,28.05,
BICITRA:15ML,31071008,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
CALCIUM CARBONATE TAB:10GR,31071036,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CALCIUM CARBONATE TAB 1250MG:1250MG,31071039,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
BICITRA 30ML DOSE,31071050,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,3.00,1.20,,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,60,,1.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,2.1,70,,1.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,32,,0.77,percent of total billed charges,32% of total billed charges,0.96,2.55,
AMPHOGEL PLAIN LIQ 1OZ,31071501,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
ALTERNAGEL:30ML,31071502,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
PROBIOTIC CAPSULE,31072503,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DONNAGEL SUSP:15ML,31072505,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CULTURELLE PED PKT,31072506,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
PEPTO-BISMOL EQ 1ML,31072508,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
CORRECTOL TABS,31073003,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOCUSATE 100 MG CAPSULE,31073004,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOCUSATE 200MG DOSE:200MG,31073005,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
CASCARA SAG FLUIDESTR OZ,31073011,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
CASTOR OIL PER OX,31073012,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,19.00,7.60,,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,60,,9.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,13.3,70,,10.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,32,,4.86,percent of total billed charges,32% of total billed charges,6.08,16.15,
SENNOSIDES LIQ 8.8MG/5ML:5ML,31073015,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DOCUSATE 100MG/CASANTHROL 30MG CAP,31073017,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BISACODYL 10 MG RECTAL SUPPOSITORY,31073021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
BISACODYL 5 MG TABLET,31073022,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
CITRUCEL DOSE,31073024,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOCUSATE 100MG/10ML LIQ,31073034,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIOCTO SYRUP 120MG/30ML:30MLS,31073035,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
METAMUCIL 5.8GM PKT:PKT,31073036,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
FIBERCON TABS,31073037,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DOCUSATE 50MG/5ML LIQ (note dose 5ml),31073060,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,8.00,3.20,,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,60,,3.84,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,5.6,70,,4.48,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,32,,2.05,percent of total billed charges,32% of total billed charges,2.56,6.8,
DRAMININE EQ TAB:50 MG,31075005,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AXID CAPSULE 150MG:NF USE PEPCID 20MG,31075027,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ESTRADIOL 1 MG TABLET,31080002,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,1.00,0.40,,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.6,60,,0.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.7,70,,0.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,32,,0.26,percent of total billed charges,32% of total billed charges,0.32,0.85,
CORTEF:20MG,31081008,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
FLUDROCORTISONE 0.1 MG TABLET,31081011,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
CORTISONE ACETATE TAB: 25MG,31081012,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
DECADRON ELIXIR:PER OZ,31081021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,26.00,10.40,,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,60,,12.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,18.2,70,,14.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,32,,6.66,percent of total billed charges,32% of total billed charges,8.32,22.1,
DECADRON TURBINAIRE: 12.6GM,31081038,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,114.00,45.60,,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,60,,54.72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,79.8,70,,63.84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,32,,29.18,percent of total billed charges,32% of total billed charges,36.48,96.9,
DECADRON ELIXIR:5 ML,31081521,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
CLIMARA 0.1MG PATCH,31084010,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
CLIMARA 0.05MG:PATCH,31084019,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
ESTRADURIN INJ:40 MG/2 ML,31084020,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,393.00,157.20,,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.8,60,,188.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,334.05,85,,267.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,275.1,70,,220.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,32,,100.61,percent of total billed charges,32% of total billed charges,125.76,334.05,
ESTRADERM PATCH,31084021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
PLAN B - EMERGENCY CONTRACEPTION,31084042,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,88.00,35.20,,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,60,,42.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,61.6,70,,49.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,32,,22.53,percent of total billed charges,32% of total billed charges,28.16,74.8,
GLIMEPIRIDE TAB 1MG:1MG,31086002,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DIABINESE TAB:250 MG,31086003,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DIABINESE TAB:100 MG,31086004,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DYMELOR TAB:250 MG,31086005,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
GLIMEPIRIDE 4 MG TABLET,31086015,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
AVANDIA 4MG:4MG,31086016,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
AVANDIA 8MG:8MG,31086017,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
PIOGLITAZONE 15 MG TABLET,31086018,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ACTOS 30MG:30MG,31086019,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ACTOS 45 MG TABLET,31086020,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,17.78,7.11,,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.67,60,,8.54,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,15.11,85,,12.09,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,12.45,70,,9.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,32,,4.55,percent of total billed charges,32% of total billed charges,5.69,15.11,
AVANDIA 2MG:2MG,31086022,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
GLIMEPIRIDE 2 MG TABLET,31086023,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
JANUVIA 50 MG TABLET,31086024,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,15.00,6.00,,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,60,,7.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,10.5,70,,8.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,32,,3.84,percent of total billed charges,32% of total billed charges,4.8,12.75,
JANUVIA 100 MG TABLET,31086025,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
JANUVIA 25 MG TABLET,31086026,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,17.00,6.80,,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,60,,8.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,11.9,70,,9.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,32,,4.35,percent of total billed charges,32% of total billed charges,5.44,14.45,
TRADJENTA 5MG TAB,31086060,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
FOSAMAX:NON-FORMULARY,31087007,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
CALCIUM CHLORIDE 10% (1 GM/10 ML) SDV,31087035,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,25.00,10.00,,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,60,,12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,17.5,70,,14,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,32,,6.4,percent of total billed charges,32% of total billed charges,8,21.25,
ABSOLUTE ALCOHOL IV : 2ML,31090017,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,87.00,34.80,,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.2,60,,41.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,60.9,70,,48.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,32,,22.27,percent of total billed charges,32% of total billed charges,27.84,73.95,
CETACAINE SPRAY:50 ML,31090030,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,81.00,32.40,,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.6,60,,38.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,56.7,70,,45.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,32,,20.74,percent of total billed charges,32% of total billed charges,25.92,68.85,
BENZOCAINE/MENTHOL 20%-0.5% SPRAY - 56GM,31090031,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,35.00,14.00,,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21,60,,16.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,24.5,70,,19.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,32,,8.96,percent of total billed charges,32% of total billed charges,11.2,29.75,
AMIDATE 40 MG/20 ML SDV,31090040,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,187.00,74.80,,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.2,60,,89.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,130.9,70,,104.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,32,,47.87,percent of total billed charges,32% of total billed charges,59.84,158.95,
ANCETINE FLO-PAK:500 MG,31090067,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,
A & D OINTMENT - 42.5 GM TUBE,31091002,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,27.00,10.80,,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,60,,12.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,18.9,70,,15.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,32,,6.91,percent of total billed charges,32% of total billed charges,8.64,22.95,
BACITRACIN ZN OINT:15GM,31091003,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,29.00,11.60,,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,60,,13.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,20.3,70,,16.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,32,,7.42,percent of total billed charges,32% of total billed charges,9.28,24.65,
AVEENO LOTION,31091008,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
AVEENO BATH OIL,31091009,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,41.00,16.40,,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.6,60,,19.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,28.7,70,,22.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,32,,10.5,percent of total billed charges,32% of total billed charges,13.12,34.85,
CORTICAINE CREAM,31091011,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CORTISPORIN CREAM:7.5GM,31091012,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
CORTISPORIN TOP OINT:1/2 OZ,31091015,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,76.00,30.40,,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,60,,36.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,53.2,70,,42.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,32,,19.46,percent of total billed charges,32% of total billed charges,24.32,64.6,
MOMETASONE FUR CRM 0.1%:45GM,31091019,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
MOMETASONE FUR OINT 0.1%:45GM,31091020,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,16.00,6.40,,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,60,,7.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,11.2,70,,8.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,32,,4.1,percent of total billed charges,32% of total billed charges,5.12,13.6,
ELOCON 0.1% CREAM 15GM:15GM,31091026,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,67.00,26.80,,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.2,60,,32.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,46.9,70,,37.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,32,,17.15,percent of total billed charges,32% of total billed charges,21.44,56.95,
CLOTRIMAZOLE CR:45GM,31091035,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
CLOTRIMAZOLE/BETAMETHASONE CREAM - 15 GM,31091036,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,70.00,28.00,,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,60,,33.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,49,70,,39.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,32,,17.92,percent of total billed charges,32% of total billed charges,22.4,59.5,
ETHYL CHLORIDE TREATMENT,31091038,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CLOTRIMAZOLE/BETAMETH CR:45GM,31091039,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,150.00,60.00,,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,60,,72,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,105,70,,84,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,32,,38.4,percent of total billed charges,32% of total billed charges,48,127.5,
FLUOCINONIDE CR 0.05% 15GM:15GM,31091054,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
FLUOCINONIDE CR 0.025% 15GM:15GM,31091056,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,21.00,8.40,,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,60,,10.08,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,14.7,70,,11.76,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,32,,5.38,percent of total billed charges,32% of total billed charges,6.72,17.85,
CLOBETASOL CRM 0.05% 30GM,31091063,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,48.00,19.20,,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,60,,23.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,33.6,70,,26.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,32,,12.29,percent of total billed charges,32% of total billed charges,15.36,40.8,
CAPSAICIN 0.1% CR:45GM,31091065,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
BEN-GAY ORIG 60GM:60GM,31091066,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
ASPERCREME 10% 90GM:90GM,31091067,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,13.00,5.20,,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,60,,6.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,9.1,70,,7.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,32,,3.33,percent of total billed charges,32% of total billed charges,4.16,11.05,
BETAMETHASONE DIP CRM 0.05% 45GM:45GM,31091069,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,37.00,14.80,,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,60,,17.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,25.9,70,,20.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,32,,9.47,percent of total billed charges,32% of total billed charges,11.84,31.45,
MUPIROCIN 2% CREAM - 15 GM TUBE,31091071,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,104.00,41.60,,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,60,,49.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,72.8,70,,58.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,32,,26.62,percent of total billed charges,32% of total billed charges,33.28,88.4,
BETAMETHASONE VAL 0.1% OI:15GM,31091079,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,28.00,11.20,,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,60,,13.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,19.6,70,,15.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,32,,7.17,percent of total billed charges,32% of total billed charges,8.96,23.8,
BUPIVICAINE 0.25% W/EPI 10ML MDV,31091089,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,61.00,24.40,,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.6,60,,29.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,42.7,70,,34.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,32,,15.62,percent of total billed charges,32% of total billed charges,19.52,51.85,
EMLA CREAM - 5 GM TUBE,31091090,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,22.00,8.80,,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,60,,10.56,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,15.4,70,,12.32,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,32,,5.63,percent of total billed charges,32% of total billed charges,7.04,18.7,
BUPIVICAINE MPF 0.5% 30ML,31091094,CDM,250,RC,J3490,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
BUPIVICAINE MPF 0.25% W/EPI 30ML,31091096,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,68.00,27.20,,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,60,,32.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,47.6,70,,38.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,32,,17.41,percent of total billed charges,32% of total billed charges,21.76,57.8,
EMLA CREAM - 30 GM TUBE,31091109,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
DECASPRAY AEROSOL:25 GM,31091110,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,69.00,27.60,,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.4,60,,33.12,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,48.3,70,,38.64,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,32,,17.66,percent of total billed charges,32% of total billed charges,22.08,58.65,
EMLA:BACTROBAN CR 1:1: 60GM,31091111,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,43.00,17.20,,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,60,,20.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,30.1,70,,24.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,32,,11.01,percent of total billed charges,32% of total billed charges,13.76,36.55,
SENSORCAINE MPF 0.75%:30ML,31091113,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,52.00,20.80,,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,60,,24.96,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,36.4,70,,29.12,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,32,,13.31,percent of total billed charges,32% of total billed charges,16.64,44.2,
HYDROCORTISONE ENEMA 60ML:60ML,31091126,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,23.00,9.20,,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,60,,11.04,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,16.1,70,,12.88,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,32,,5.89,percent of total billed charges,32% of total billed charges,7.36,19.55,
AVC VAG CREAM W/ APPL:4 OZ,31091128,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,100.00,40.00,,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,60,,48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,70,70,,56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,32,,25.6,percent of total billed charges,32% of total billed charges,32,85,
AVC VAG SUPP BOX :16 W/APPL,31091136,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
AVC W/DIENEST VAG CR:4 OZ,31091137,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,106.00,42.40,,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,60,,50.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,74.2,70,,59.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,32,,27.14,percent of total billed charges,32% of total billed charges,33.92,90.1,
FURACIN SOL DRESSING 1 LB,31091151,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,191.00,76.40,,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.6,60,,91.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,133.7,70,,106.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,32,,48.9,percent of total billed charges,32% of total billed charges,61.12,162.35,
BALMEX TUBE: 2OZ,31091153,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
AMERIGEL WOUND DRESSING 30GM:30GM,31091174,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,45.00,18.00,,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27,60,,21.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,31.5,70,,25.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,32,,11.52,percent of total billed charges,32% of total billed charges,14.4,38.25,
CALAMINE LOTION - 177 ML BOTTLE,31091186,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
AMLACTIN 12% CRM:AMLACTIN 140GM,31091188,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,42.00,16.80,,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,60,,20.16,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,29.4,70,,23.52,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,32,,10.75,percent of total billed charges,32% of total billed charges,13.44,35.7,
CROTAMITON CREAM:60GM,31091194,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,75.00,30.00,,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45,60,,36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,52.5,70,,42,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,32,,19.2,percent of total billed charges,32% of total billed charges,24,63.75,
ANUSOL SUPP PLAIN,31091224,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ANUSOL 25 MG RECTAL SUPPOSITORY,31091225,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
DESOXIMETASONE CR 0.25% 15GM:0.25%,31091230,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,79.00,31.60,,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.4,60,,37.92,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,55.3,70,,44.24,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,32,,20.22,percent of total billed charges,32% of total billed charges,25.28,67.15,
TUCKS OINTMENT 28GM:28GM,31091254,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,24.00,9.60,,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,60,,11.52,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,16.8,70,,13.44,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,32,,6.14,percent of total billed charges,32% of total billed charges,7.68,20.4,
PROCTOZONE HC CREAM - 30 GM TUBE,31091256,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,27.90,11.16,,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.74,60,,13.39,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,23.72,85,,18.98,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,19.53,70,,15.62,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,32,,7.14,percent of total billed charges,32% of total billed charges,8.93,23.72,
DESOXIMETASONE CR 0.05% 60GM:0.05%,31091262,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
DESOXIMETASONE OINT 0.25% 15GM:0.25%,31091264,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,107.00,42.80,,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.2,60,,51.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,74.9,70,,59.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,32,,27.39,percent of total billed charges,32% of total billed charges,34.24,90.95,
DONNATAL TAB,31092010,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
OXYBUTYNIN ER 5 MG TABLET,31092019,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
DETROL TAB:2MG,31092021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
TOLTERODINE ER 4MG CAP,31092023,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,9.00,3.60,,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,60,,4.32,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,6.3,70,,5.04,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,32,,2.3,percent of total billed charges,32% of total billed charges,2.88,7.65,
DONNATAL ELIXIR: 1 OZ,31092024,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,20.00,8.00,,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,60,,9.6,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,14,70,,11.2,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,32,,5.12,percent of total billed charges,32% of total billed charges,6.4,17,
DETROL-LA 2MG CAP:2MG,31092025,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,11.00,4.40,,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,60,,5.28,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,7.7,70,,6.16,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,32,,2.82,percent of total billed charges,32% of total billed charges,3.52,9.35,
AMINOPHYLLIN SUPP:500MG,31092033,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
AMINOPHYLLIN SUPP:250 MG,31092060,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
ASCORBIC ACID 250MG:250MG,31093042,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,38.00,15.20,,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,60,,18.24,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,26.6,70,,21.28,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32,,9.73,percent of total billed charges,32% of total billed charges,12.16,32.3,
FOLIC ACID 50 MG/10 ML MDV - PER 1 MG,31093051,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
BETA-CAROTENE CAPSULE: 25MU,31093054,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,5.00,2.00,,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,60,,2.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,3.5,70,,2.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,32,,1.28,percent of total billed charges,32% of total billed charges,1.6,4.25,
ENSURE:240 ML,31093130,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ENSURE PLUS HN:240ML,31093137,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
BOOST VANILLA:240ML,31093144,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
BOOST CHOC:240ML,31093145,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,10.00,4.00,,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,60,,4.8,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,7,70,,5.6,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,32,,2.56,percent of total billed charges,32% of total billed charges,3.2,8.5,
ALLOPURINOL 100 MG TABLET,31094008,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,6.00,2.40,,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,60,,2.88,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,4.2,70,,3.36,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,32,,1.54,percent of total billed charges,32% of total billed charges,1.92,5.1,
COLCHICINE INJ 1 MG 2 ML,31094013,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,53.00,21.20,,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,60,,25.44,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,37.1,70,,29.68,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,32,,13.57,percent of total billed charges,32% of total billed charges,16.96,45.05,
AZATHIOPRINE 50MG TAB,31094014,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
COLESTID 1GM TAB,31094021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
DAKIN'S 0.5% - FULL STRENGTH,31094060,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,57.00,22.80,,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.2,60,,27.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,39.9,70,,31.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,32,,14.59,percent of total billed charges,32% of total billed charges,18.24,48.45,
SSRI,31094065,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,51.00,20.40,,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,60,,24.48,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,35.7,70,,28.56,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,32,,13.06,percent of total billed charges,32% of total billed charges,16.32,43.35,
ELDEPRYL TAB: 5MG,31094079,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,18.00,7.20,,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,60,,8.64,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,12.6,70,,10.08,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,32,,4.61,percent of total billed charges,32% of total billed charges,5.76,15.3,
ALLOPURINOL 300 MG TABLET,31094085,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,7.00,2.80,,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,60,,3.36,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,4.9,70,,3.92,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,32,,1.79,percent of total billed charges,32% of total billed charges,2.24,5.95,
CALCIMER:400 UNITS,31095012,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,240.00,96.00,,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,60,,115.2,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,168,70,,134.4,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,32,,61.44,percent of total billed charges,32% of total billed charges,76.8,204,
AEROCHAMBER FOR MDI,31095021,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,141.00,56.40,,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.6,60,,67.68,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,119.85,85,,95.88,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,98.7,70,,78.96,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,32,,36.1,percent of total billed charges,32% of total billed charges,45.12,119.85,
EVISTA 60 MG TABLET,31095023,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,12.00,4.80,,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,60,,5.76,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,8.4,70,,6.72,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,32,,3.07,percent of total billed charges,32% of total billed charges,3.84,10.2,
COSOPT OPHTH 5ML:5ML,31161147,CDM,250,RC,99088,HCPCS,OUTPATIENT,,,130.00,52.00,,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78,60,,62.4,percent of total billed charges,60% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,91,70,,72.8,percent of total billed charges,70% of total billed charges,,,,,other ,not seperately reimbursable,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,32,,33.28,percent of total billed charges,32% of total billed charges,41.6,110.5,